Homodigital Pedicled Digital Artery Perforator flaps for fingertip reconstruction - a review of flap options

Abstract

Background: Digital artery perforator flaps provide a useful option for reconstruction of soft tissue defects of the digits, and many variations of these flaps have been described for fingertip defects. This review aims to summarize various pedicled digital artery perforator flap anatomical configurations described in literature for fingertip reconstruction and their results.

Methods: A literature review of PubMed, Medline and Embase databases was conducted. Studies reporting homodigital digital artery perforator flaps for fingertip reconstruction without sacrificing the proper digital artery were included in the review. Data collected included flap design, perforator location, pathology, defect location, flap dimensions, flap survival, sensory recovery, range of movement, outcome measures, and complications. The flaps were analysed and categorized based on flap location, flap design, transfer method, and flap innervation.

Results: Pedicled digital artery perforators have been described in various configurations by different authors including propeller, bilobed, V-Y advancement, rotation and turnover flaps. Variations to make these flaps sensate have also been described. According to the available reports, these flaps have low complications and high patient satisfaction rates.

Conclusion: Pedicled digital artery perforator flaps provide a versatile option for the reconstruction of fingertip and thumb tip defects. Various flap options are available for use depending on the reconstructive need. They are quicker and easier to perform than free flaps and can provide excellent outcomes in suitable cases.

Keywords: DAP flap; Digital artery perforator flap; Fingertip reconstruction; Homodigital perforator flap; Islanded digital artery perforator flap.

Figure 1

Study selection process flow chart (from the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement).

Figure 2

Illustration of various DAP flap configurations identified from review showing potential arc of rotation. (A) Lateral DAP propeller flap. (B) Adiposal only DAP propeller flap. (C) Adipo-cutaneous DAP propeller flap. (D) Dorsal DAP propeller flap. (E) Dorsal Adipofascial Digital Artery Perforator (DADAP) flap (F) Bilobed DAP flap. (G) Dorsal V-Y DAP flap. (H) Lateral V-Y DAP flap for transverse tip amputations. (I) Lateral V-Y DAP flap for distal lateral defects. (J) Dorsal rotation DAP flap. (K) Volar DAP flap. (L) Modified dorsolateral proximal phalangeal (MDPP) island flap.