Free Vascularized Mini-Flaps in Replantation of the Digits

Abstract

Free vascularized mini-flaps have been used in 18 patients with digital replantations since 1989. The mini-flaps were only 1 × 2 cm to 3 × 4 cm in size. These flaps were harvested from abandoned digits in 12 cases and from venous flaps of the forearm in six cases. The flaps taken from a useless finger included the extensor tendons in two, digital nerves in six and interphalangeal joints in one case. The primary surgical indication for the mini-flap was excessive soft tissue loss with vascular defects in the digits with intact phalanges. The mini-flap was also indicated in cases with severe injuries of several digits in which vascularized nerves, phalanges or interphalangeal joints were available from the relatively unimportant digits, and there was need to reconstruct these structures in functionally important digits. The methods of vascular anastomosis of the flaps included: (1) interposition graft of the vessels with the flaps between the proximal and distal parts of the amputation; (2) arterial–venous bypass anastomosis; and (3) arterial–venous network anastomosis. All the mini-flaps survived with fairly good functional return. This study provides new approaches for severe crush injuries in amputated digits, which had been considered previously as not suitable for replantation.