The use of innervated radial artery superficial palmar branch perforator free flap for complex digital injuries reconstruction.

Loco-regional flaps have been widely used for the reconstruction of digital injuries without requiring microvascular anastomosis, however, they result in scarring and compromised functional outcomes. This study demonstrates our experience utilizing the innervated radial artery superficial palmar branch (RASPB) perforator free flap for complex digital injury reconstruction. From May 2007 to March 2014, the innervated RASPB perforator free flap was used to reconstruct 79 distal complex hand and digital soft tissue defects of which 14 were used to re-vascularise the distal digit in a flow-through fashion. All free flaps were innervated by the palmar cutaneous branch of the median nerve. All 79 free flaps survived and all 14 digits re-vascularized successfully. One flow-through free flap developed distal skin necrosis which healed uneventfully without further procedure. The average follow-up was 21.5 months. Measurement of two-point discrimination ranged from 7 to 13 mm. All patients were satisfied with the aesthetic results. The innervated RASPB perforator free flap is a feasible and effective option for the reconstruction of complex digital defects and the flow-through concept, when utilized in cases with compromised vascularity, provides reliable re-vascularization. Level III, therapeutic study.

Chimeric thoracoacromial artery perforator flap for one-staged reconstruction of complex pharyngoesophageal defects: A single unit experience.

BACKGROUND: Circumferential hypopharyngeal defects with anterior neck skin loss often require double-stacked or chimeric flaps to achieve good surgical outcomes. The thoracoacromial artery perforator (TAAP) flap is a simple and reliable method for hypopharyngeal defect reconstruction. METHODS: From March 2012 to February 2015, 19 male patients with an average age of 62 years (range 42-81 years) underwent complex pharyngoesophageal defect reconstruction with chimeric TAAP flaps. RESULTS: All 19 male patients who underwent reconstruction with TAAP flaps achieved optimal functional outcomes. All donor sites were closed primarily. The average length of hospital stay was 12.5 days (range 10-19 days). All patients returned back to normal nutrition after 8 weeks postoperatively. The average follow-up period was 19.3 months (range 14-48 months). CONCLUSION: The chimeric TAAP flap is an innovative local alternative solution for reconstruction of complex circumferential hypopharyngeal defects when free tissue transfer is contraindicated or neck vessels are depleted.