Table 3.
Clinical Studies from Included Authors
| Author | Region | No. CP | Width (mm) |
Pedicle (mm) |
Clinical Subjects | Flap | Donor | Outcome |
|---|---|---|---|---|---|---|---|---|
| Braga-Silva et al20,41 | Dorsal 1st – 5th digits | 5 per digit | 0.3 (0.2–0.4) |
NS | 54 patients, 56 flaps, age 5–60 y (av. 27). Defects on dorsal digits of the middle and distal long fingers, and proximal and distal thumb | Adipo-fascial flap (18 × 16–42 × 18 mm) from proximal & middle phalanx, based on the 3rd and 4th PPDA CPs, flipped distally. Pivot: lateral PIPJ. The flap was then covered by STSG | DC | Success in all flaps, no necrosis, infection, or remarkable tendon adhesion. 15% loss of skin graft (1), dissatisfied with donor scar (2). Active flexion deficits: 50%–80% deficit |
| Endo et al28 | Dorsal digit | 5 per digit | 0.4 (0.2–0.6) |
NS | 3 patients. Only 1 case was presented, with a defect on the left ring distal finger pulp | Innervated reverse vascular pedicle digital island flap (size 20 × 15 mm) at the dorsolateral side of finger base (4th digit) based on PPDA CPs | FTSG | Success (1 case). 10 months post-operative: good sensation in flap, moving 2PD = 4 mm, recovered full flexion, slight extension lag in DIPJ. (No information on the other 2 cases) |
| Valenti et al29 | Dorsal proximal digits | 3 per digit | NS | NS | Defect on dorsal distal phalanx of the 3rd digit | Dorso-commisural flap between MCP heads, based on 3rd PPDA CP that anastomose with DMA CPs. Pivot: lateral PIPJ | DC/SG | NS |
| Quaba et al30 | Distal third of dorsal hand | 1 per intermetacarpal space | 0.3–0.5 | NS | 21 patients, age 9–60 y (av. 31). Defects on the intermetacarpal space (11), dorsal MCP (4), dorsal phalanx (3), distal palm (3) | Skin flap (size 10 × 15 mm up to 90 × 30 mm) based on the distal DMA CP, 5–10 mm proximal to MCPJ, distal to JT, taken from the 3rd (11), 2nd (8), and 4th (2) intermetacarpal spaces | 3 STSG, 4 FTSG, 14 DC | 1 failed, 1 partial loss (venous congestion results in superficial necrosis), 1 tip necrosis (in long flap meant to cover distal palm). In 1 case, venous micro-anastomosis is done to relieve venous congestion |
| Liu et al31 | Dorsal distal hand | 4–8 per intermetacarpal space | 0.42 ± 0.16 | 6.38 ± 1.94 | 1 patient, age 30 years. Defect on the dorsal middle and distal phalanx of right index finger | Skin chain-link flap (size 45 × 25 mm) based on 2nd DMA CP + neurorrhaphy. Pivot: 1st cluster (between MCP heads) | DC | Successful. 12 months postoperative, static 2PD = 6.5 mm |
| Facchin et al32 | Dorsal distal hand | 1–3 per intermetacarpal space | 0.6 ± 0.27 | NS | 1 patient, age 35 years, defects at the 2nd–5th dorsal finger | Adipofascial turnover flap based on 2nd–5th distal DMA CPs (size: wrist dorsal crease to distal DMA CPs) (syndactilization) + tendon graft + dermal substitute, then covered with skin graft. Pivot: distal DMA | DC | Full recovery after 3 months, ROM 72%, reduced sensitivity of fine touch on dorsal hand, normal sensitivity on all dorsum phalanx |
| Hu et al33 | 1st intermetacarpal space | 3–5 in palmar, 3 in dorsal |
0.1–1.1 (av. 0.73) | 0.6–1.9 | 7 patients, age 30–54 y (av. 42). Defects on proximal dorsal index finger (2), proximal palmar index finger (2), distal dorsal thumb (2), thenar (1) | Skin flap from UPDAT/RPDAIF (size 15 × 10 mm up to 56 × 31 mm). Pivot: 1 cm proximal middle palmar crease edge, 1 cm proximal thumb palmar crease edge | <1 cm: DC, >1 cm: SG |
6 flaps survived, 1 flap for dorsal thumb defect had partial necrosis and healed well after treatment. 2–36 months follow-up: healthy skin color, 2PD +, no contracture on 1st web |
| Hu et al34 | Dorsal wrist | 2–7 | 0.1–1 (av. 0.45) | 0.4–1.4 | 9 patients, age 5–47 y (av. 24.5). Defects in the dorsal hand | VY-advancement flap (50 × 28–100 × 50 mm) based on dorsal wrist perforators. Pivot: dorsal wrist perforator origin | ≤3 cm: DC >3 cm: SG |
All flaps survive; 3–40 months follow-up: excellent color, texture, satisfactory appearance, normal movement of wrist joint |
| Omokawa et al13,54 | Midpalm | 14–30 | 0.1–0.5 | NS | 15 patients, age 23–68 y (av. 41). Fingertip amputation (10), soft tissue defects (5) | Skin flap (25 × 15–45 × 0 mm) from transverse distal mid palm (11) and longitudinal radial mid palm (4). Neurorrhaphy done in 6 cases | DC (12), SG (3) |
All flaps survived, no complications. Follow-up ± 4 y. Additional Z-plasties (2) and nail plasty (1). Fingertip atrophy due to bone resorption (1). No pain, joint contracture, cold intolerance. Moving 2PD at innervated flap 6 mm, at non-innervated flap 10 mm |
| Uchida et al35 | Distal hypothenar | 3–7 (av. 5) | NS | NS | 1 patient, 56 y, Dupuytren contracture on left little finger (flexion contracture > 60 degrees) grade 3 Meyerdling Classification | Skin flap (21 × 38 mm) from distal ulnar palmar digital artery perforator | DC | Successful, after 2 months, contracture improved, no recurrence/complications, good color and texture |
| Hao et al36 | Postero-medial dorsum of the ulnar hand | 1 | 0.8 ± 0.2 | NS | 16 patients, age 17–62 y (av. 31.5). Crush (8), planers (4), explosion (2), burn (2) resulting in little finger and distal hypothenar defects | Skin flap (25 × 15–60 × 35 mm) based on the ulnar palmar digital artery perforator. Pivot: 13 ± 3 mm proximal to the 5th metacarpophalangeal joint | DC/SG | All flaps survived, no complications, sometimes there was slight congestion in early postoperative that subsided subsequently. After 7–16 weeks follow-up, color was similar and patients could resume daily activities |
| Pak et al37 | Proximal hypothenar | 1 | 0.9 ± 0.15 | 11.25 ± 1.67 | 44 patients, age 20–62 y (av. 42.7). Defects on fingertips | Free skin flap (up to 25 × 35 mm) from palmar ulnar artery perforator for fingertip defects + neurorrhaphy | DC | One had partial loss due to venous congestion. 6 months postoperative 2PD = 5.7 mm |
| Daniel Postan42 | Proximal hypothenar | 1 | NS | NS | 1 patient, 50 y. Defect on the volar wrist | Skin flap (width: 20 mm, length: wrist skin fold to MCPJ), based on CBDPA. Pivot: 10 mm distal from distal edge of pisiform. Neurorrhaphy was done | DC + SG | Successful, no complication, complete wrist movements, 2PD before = 6 mm, after 2 months postoperative = 8 mm |
av., average; CBDPA, cutaneous branch of deep palmar artery; CP, cutaneous perforator; DC, direct closure; DIPJ, distal interphalangeal joint; DMA, dorsal metacarpal artery; FTSG, full thickness skin graft; MCP, metacarpal; MCPJ, metacarpophalangeal joint; NS, not stated; PIPJ, proximal interphalangeal joint; PPDA, proper palmar digital artery; RPDAIF, radial palmar digital artery of the index finger; SG, skin graft; STSG, split thickness skin graft; yo, years old; UPDAT, ulnar palmar digital artery of the thumb; 2PD, 2-point discrimination.