Arch Hand Microsurg 2019; 24(4): 368-375  
Reconstruction of Multiple Fingertip Defects Using the Innervated Radial Artery Superficial Palmar Branch Perforator Flap
Junsang Lee1, Hyun Sik Park2, Bum Suk Oh2, Jong Ick Whang1, Hyung Gyo Seo1
Departments of 1Plastic and Reconstructive Surgery and 2Orthopedic Surgery, Institute of Hand and Microsurgery, Duson Hospital, Ansan, Korea
Correspondence to: Junsang Lee
Department of Plastic and Reconstructive Surgery, Institute of Hand and Microsurgery, Duson Hospital, 114 Seonbugwangjang 1-ro, Danwon-gu, Ansan 15368, Korea
TEL: +82-31-402-0114, FAX: +82-31-414-1903, E-mail: junsang9180@gmail.com, ORCID: https://orcid.org/0000-0001-6557-3027
Received: May 28, 2019; Revised: September 23, 2019; Accepted: September 26, 2019; Published online: December 1, 2019.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: The reconstruction of posttraumatic fingertip defects requires adequate soft tissue coverage, sensibility and minimal donor site morbidity. Reconstruction is more difficult in the case of multiple fingertip defects. The purpose of this study was to report the results of reconstruction of multiple fingertip defects using the innervated radial artery superficial palmar branch perforator flap (iRASP).
Methods: We performed 19 cases of the iRASP for the reconstruction of multiple fingertip defects. The surgery was performed in two stages. In the first stage, defects were covered with the iRASP. In the second stage, the flap was divided 2-3 weeks after the first operation.
Results: All flaps survived. At the last follow-up, static two-point discrimination was measured. A mean of 7.6 mm (6-9 mm) was measured on the affected side and 3.6 mm (2-5 mm) on the contralateral side. The sensory examination was performed at a mean 6.8 months (4-11 months) after surgery. Postoperatively, some patients complained of pain in the donor scars, but most of them disappeared after six months. Debulking surgery was not needed to improve the contours.
Conclusion: We reconstructed multiple fingertip defects using the iRASP, and obtained satisfactory functional and cosmetic results. Four fingertip defects could be reconstructed with one flap and with satisfactory sensory recovery. Therefore, the iRASP is considered an appropriate treatment for reconstruction of multiple fingertip defects.
Keywords: Free flap, Finger, Injury


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