Wong Celestial Xin Lu, Xie Jia Lin Sophie, Sechachalam Sreedharan, Wong Jian Hao Kevin, Lee Munn Yi Tina
Trinity College Dublin, Ireland.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
J Hand Microsurg. 2025 May 12;17(4):100279. doi: 10.1016/j.jham.2025.100279. eCollection 2025 Jul.
Our study aims to share our surgical experiences in utilising the dorsoulnar artery perforator-based (DUAP) free flap for reconstruction of medium-sized defects of the digits.
Five patients, from 2014 to 2022, all of whom sustained critical defects of the digit(s), either due to trauma or infection, underwent resurfacing with an ipsilateral DUAP free flap. The size of the defects ranged from 2.5 to 3.5 cm in width and 3.5 to 7 cm in length. The main outcomes included active range of movement, sensory recovery of the flap, and time to return to work.
All five patients demonstrated favourable outcomes following reconstruction of medium-sized digital defects using the DUAP free flap. The patients were followed up for an average of 5 months postoperatively. There were no cases of partial or complete flap failure, and none of the cases required re-exploration of anastomoses. Flap neurotisation was performed in selected cases using either end-to-end or end-to-side neurorrhaphy, achieving a 2-point discrimination of up to 7 mm at 10 weeks postoperatively. All donor sites had healed well and demonstrated good final wrist range of movement, even when flaps extended into the ulnar wrist crease. Technicial refinements included adjusting the flap position to accommodate longer pedicle lengths for defects with short recipient vessels or a wider zone of injury, using a cuff of the main ulnar artery for anastomosis in cases of vessel size mismatch, and using either the dorsal digital vein or superficial dorsal hand vein to mitigate venous congestion.End-to-side (ETS) neurotization was performed in one of the cases, which allowed for preservation of thumb sensation.
The DUAP free flap is reliable and consistently reproducible and serves as a good option for reconstruction of medium-sized defects of the digit. It provides satisfactory functional and aesthetic outcomes, minimal donor site morbidity and the potential for sensory restoration through end-to-end and end-to-side neurotisation. Our experience supports the application of this flap beyond pulp defects, especially when selected technical modifications are employed to address the individual anatomical challenges and optimze outcomes.
我们的研究旨在分享利用基于尺背动脉穿支的游离皮瓣（DUAP）修复手指中等大小缺损的手术经验。
2014年至2022年期间，5例患者因创伤或感染导致手指严重缺损，均接受了同侧DUAP游离皮瓣修复术。缺损大小为宽2.5至3.5厘米，长3.5至7厘米。主要观察指标包括主动活动范围、皮瓣感觉恢复情况以及恢复工作的时间。
所有5例患者采用DUAP游离皮瓣修复手指中等大小缺损后均取得了良好效果。患者术后平均随访5个月。未出现部分或完全皮瓣坏死病例，无一例需要再次探查吻合口。部分病例采用端端或端侧神经缝合进行皮瓣神经化，术后10周两点辨别觉可达7毫米。所有供区愈合良好，即使皮瓣延伸至尺侧腕横纹，最终腕关节活动范围也良好。技术改进包括：对于受区血管短或损伤范围广的缺损，调整皮瓣位置以适应更长的蒂长度；血管大小不匹配时，使用尺侧主要动脉袖套进行吻合；使用指背静脉或手背浅静脉减轻静脉淤血。其中1例进行了端侧神经化，得以保留拇指感觉。
DUAP游离皮瓣可靠且可重复性强，是修复手指中等大小缺损的良好选择。它能提供令人满意的功能和美学效果，供区并发症少，通过端端和端侧神经化有感觉恢复的潜力。我们的经验支持该皮瓣在除指腹缺损外的其他情况中的应用，特别是采用特定技术改进来应对个体解剖挑战并优化结果时。
4级
