Background: Reconstruction of severe hand injuries remains a challenge. We herein report the use of dorsalis pedis composite free flaps (DPCFFs) for the reconstruction of penetrating injuries of the hand.
Methods: From July 2001 to February 2009, 23 patients (15 males and 8 females), mean age of 26 years (range, 17-48 years), with penetrating wounds of the hand were treated with DPCFFs. A second toe composite flap was used in cases of bone, joint, tendon and skin defects, and combined flaps were used for patients with only soft-tissue defects. Total joint transplantation using the proximal interphalangeal joint of the second toe was used in 10 cases, compound flaps using the metatarsophalangeal joint of the second toe were used in six, and combined dorsalis pedis flaps were used in seven cases of soft-tissue loss.
Results: All flaps survived, no bone nonunion or malunion occurred, and primary healing was achieved at all recipient and donor sites. Mean follow-up was 11 months (range, 6-27 months). In all cases, hand function was satisfactory and aesthetic outcome was good. Sensory recovery ranged from S2 to S3. In six cases with transplanted metatarsophalangeal joints, the mean range of flexion and extension was 45° (range, 30-70°). In 11 cases with transplanted proximal interphalangeal joints, the mean range of flexion and extension was 65° (range, 35-90°). No patient experienced difficulty walking.
Conclusion: DPCFFs are useful for the repair of composite tissue defects of the hand.
Levels of evidence: III.
Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.