Refinements of Adipofascial flap for Small Defects of Fingers and Toes: Indication and Surgical Tips

ABSTRACT

PURPOSE: Reconstruction of small defects of the dorsal fingers and toes is a challenging task. Although adipofascial flap is widely used for these areas, additional refinements are warranted. In this paper, we define the appropriate defect size in the finger and toes that can be treated with the adipofascial flap, refine its surgical indications and present a few surgical tips. MATERIALS AND METHODS: Twelve patients with dorsal defects of the fingers and toes were treated with a random-type adipofascial turn-over flap and skin graft. If the defect area exceeded the size that could be covered by a conventional design, the flap base was designed in oblique or curvilinear fashion to lengthen the flap. For accurate defect coverage, the width of the flap base was designed in an asymmetrical shape depending on the defect configuration, varying the width from 0.3 to 1.0 cm, as opposed to the standard 0.5 to 1.0 cm width. Moreover, the lateral limit of the flap was defined as the lateral axial line. The size of the defect ranged from 3.0×1.7 cm to 1.5×1.3 cm. RESULTS: All flaps survived completely. Gliding function of the hand was well preserved and there was no evidence of tendon adhesion. CONCLUSION: The small defect in the dorsal finger and toe can be defined as less than one phalanx-length, measuring about 3.0×2.0 cm in size. If the defect exceeds this dimension, it is recommended that a different option be considered. We believe the adipofascial flap is an excellent option for treating small defects.