Temporary Ectopic Implantation of a Single Finger Using a Perforator as a Feeding Vessel, and Subsequent Prefabricated Chimeric Flap Transplantation.

OBJECTIVE: Ectopic implantation was first reported by Godina in 1986. We herein present 2 cases in which amputated fingers were salvaged and reconstructed by means of temporary ectopic implantation utilizing perforator anastomoses and chimeric flaps. METHODS: Case 1. A 30-year-old man injured his right hand. All of the fingers were completely crushed with the exception of the little finger. We performed an ectopic implantation by using the superficial circumflex iliac artery perforator. Three months later, the little finger was transplanted with the superficial circumflex iliac artery perforator flap, vascularized nerve, and the 2nd metacarpal bone. Case 2. A 29-year-old man suffered a degloving injury of the index finger. The digital artery was anastomosed to deep inferior epigastric artery perforator. One month later, a deep inferior epigastric artery perforator flap containing the ectopically transplanted index finger was transplanted, but the index fingertip became pale and necrotized. After debridement, a hemipulp transplantation was performed. RESULTS/CONCLUSIONS: As the diameter of perforators is similar to that of digital arteries, and perforators are capable of supplying large areas of tissue, they can be used as recipient vessels for ectopic implantation in finger salvage procedures. Another advantage of perforators as feeding vessels in ectopic implantation is the possibility of forming an ectopic chimera; the finger can be incorporated as a part of the chimeric reconstructive flap. With respect to these advantages, the perforator can be used as a feeder in an ectopic implantation of single finger.

Reconstruction of the larynx and aryepiglottic fold using a free radial forearm tendocutaneous flap after partial laryngopharyngectomy: a case report.

The patient was a 62-year-old man with chief complaints of pharyngeal pain and dysphagia. He was diagnosed with pyriform sinus poorly differentiated squamous cell carcinoma T3N0M0 (Stage II) and underwent partial laryngopharyngectomy, lymphadenectomy in the right neck, tracheostomy, and reconstruction of the larynx and aryepiglottic fold with a free radial forearm flap and the associated vascularized palmaris longus tendon. No particular problems occurred after surgery, and swallowing and articulation functions were successfully recovered. A free jejunum transfer is the first choice for reconstruction of a defect after partial hypopharyngectomy, but reconstruction of the supracricoid complex structure of the larynx using a free jejunum transfer after partial laryngopharyngectomy may lead to aspiration of intestinal fluids. In this case, we performed functional reconstruction of the laryngopharyngeal defect using a free radial forearm flap including a vascularized tendon of the palmaris longus, and satisfactory postoperative function was achieved. We believe that the key to successful functional recovery after partial laryngopharyngectomy is establishment of the three-dimensional complex structure of the arytenoid and aryepiglottic fold.

Digital artery perforator (DAP) flaps: modifications for fingertip and finger stump reconstruction.

UNLABELLED: Various fingertip reconstructions have been reported for situations where microsurgical finger replantation is impossible. One method is the digital artery perforator (DAP) flap. Herein we report 13 DAP flaps for fingertip and finger stump reconstruction following traumatic finger amputations, highlighting modifications to the originally described DAP flap. METHODS: From October 1998 to December 2007, a total of 13 fingers (11 patients) underwent fingertip and finger stump reconstruction with modified DAP flaps following traumatic finger amputations. We performed six adipocutaneous flaps, three adipose-only flaps, two supercharged flaps and two extended flaps. Flap size ranged from 1.44 to 8 cm(2) (average 3.25 cm(2)). RESULTS: All flaps survived completely with the exception of partial skin necrosis in two cases. One of these cases required debridement and skin grafting. Our initial three cases used donor-site skin grafting. The donor site was closed primarily in the 10 subsequent cases. No patients showed postoperative hypersensitivity of repaired fingertips. Semmes-Weinstein (SW) test result for flaps including a digital nerve branch did not differ from those without (average 4.07 vs. 3.92). CONCLUSIONS: Modified DAP flaps allow for preservation of digital length, volume and finger function. They can be raised as adiposal-only flaps or extended flaps and supercharged through perforator-to-perforator anastomoses. The donor defect on the lateral pulp can be closed primarily or by skin grafting. For traumatic fingertip and finger stump reconstructions, DAP flaps deliver consistent aesthetic and functional results.