11.5 THE DISTALLY BASED DORSAL METACARPALAND FINGER FLAPS WITHOUT AXIAL ARTERYFOR FINGER RESURFACINGM. Calcagni 1 , A. Biraima 1 , G. Pivato 2 , T. Hotz 1 andK. Ka¨ ch 11 Kantonsspital Winterthur, Winterthur, Switzerland;2 University of Milan, Milan, ItalyBackground: The dorsal aspect of the hand is a na-tural donor site for reconstruction of f i nger defects.The arterial anatomy shows some variations andtraditional dorso-metacarpal f l aps based on the truedorsal metacarpal arteries have been often consideredas not reliable and with a limited arch of rotation.In order to overcome these limitations and draw-backs we base our f l aps since 2003 on the dorsalbranches of the palmar digital arteries at the proximal ordistal phalanx and on the dorsal superf i cial vascularnetwork.Patients and methods: In 2003 to 2005 we operated 31patients for traumatic long f i nger defects (30 dorsal, onepalmar). Four f l aps were harvested in the secondintermetacarpal space, eight in the third and three inthe fourth, all others were harvested at the dorso-lateralsurface of the f i rst or second phalanx.Results: Survival rate was 100% for metacarpal f l apsand 94% for dorso-lateral f i nger f l aps. Minor complica-tions, as marginal necrosis or wound infection, wereexperienced in two cases of metacarpal f l aps and in fourcases of dorso-lateral f i nger f l aps.Discussion: Dorso-metacarpal and dorso-lateral f i ngerf l aps based on the superf i cial vascular network arereliable and allow for resurfacing of most dorsalf i nger defects upto the DIP joint and of more pro-ximal palmar defects. Advantages of these f l aps arethe sparing of the digital arteries, a wide arc of ro-tation and an easy dissection technique which isindependent from anatomical variations. Disadvan-tages are the exposed donor defect, which can beunattractive especially when a split thickness skin graftis necessary, and the limited f l ap width in order to avoidgrafting.10.1016/j.jhsb.2006.03.04411.6 HOMODIGITAL REVERSED DIGITAL ISLANDFLAP WITH PROPER DIGITAL NERVEA. AydinIstanbul University, TurkeyBackground: Finger pulp defects can be repaired bymany f l aps including advancement, cross f i nger anddistant f l aps. The homodigital island f l ap is a well-established technique for f i ngertip reconstruction.Aim: The aim of this presentation is to pre-sent our experience with reversed homodigitalisland f l aps in which the proper digital nerve is alsoincluded.Patients and methods: We have operated on 17 patients(ages 14–46) with this technique in 3 years.Results: All patients had a successful soft-tissuecoverage and average static two-point discriminationof 4mm, moving two-point discrimination of 3mmand diminished light touch on Semmes–Weinsteinassessment.Discussion: The homodigital island f l ap has the advan-tage that the operation is conf i ned to one operative f i eld,it is a single-stage operation, the donor site is wellhidden and it provides suff i cient soft-tissue coverage forexposed bone and tendon. In the standard techniquewhich leaves the proper digital nerve intact, sensoryrecovery is limited and dissection of the vascular pedicleis tedious. In situations where the f i ngertip pulp is lostcompletely, there is no need to leave the nerve in situbecause the pulp, which is the most important part ofthe volar surface innervated by the proper digital nerve,is lost. However, the proper digital nerve can beincluded in the pedicle and the nerve can be sutured tothe stump of the opposite proper digital nerve. Thismethod improves venous drainage of the f l ap becausethere is less risk of damaging the tiny veins and theperineural veins are also included in the f l ap pedicle.Dissection becomes easy and the f l ap may provideexcellent sensory recovery.Conclusion: This f l ap was found reliable, quite easy andquick to raise.10.1016/j.jhsb.2006.03.04511.7 REFINEMENTS OF FREE FLAP COVERAGE ATTHE DORSUM OF THE HAND AND THE FOREARMT. Gohla, A. Kehrer, K. Megerle, G. Germann andM. SauerbierBg-Unfallklinik Ludwigshafen-Klinik Fur Hand-; Plas-tische-Und Rekonstruktive Chirurgie-Schwerbrandv,Ludwigshafen, GermanyBackground: Free f l ap coverage of exposed func-tional structures of the hand and the forearm canbe achieved by a great variety of f l aps. However,there is a lack of data which tissue components arefunctionally and aesthetically suitable in this specif i carea regarding aspects such as tendon gliding and tissueelasticity.Objective: The purpose of this retrospective study was toevaluate the functional and aesthetic results of freecutaneous, fascial and muscle f l aps.Patients and methods: Between 1994 and 2002, a total of56 patients underwent free f l ap defect coverage of thisARTICLE IN PRESSTHE JOURNAL OF HAND SURGERY VOL. 31B No. S1 JUNE 2006 54
