Francisco del Piñal, MD, PhD, Melissa Klausmeyer, MD, Eduardo Moraleda, MD, Guillermo H. de Piero, MD, Jaime S. Rúas, MD, Maciej Klich, MD

Journal of Hand Surgery American Edition Vol. 40, Issue 6, June 2015, Pages 1152-1160 – © 2015 by the American Society for Surgery of the Hand – All rights reserved.

ABSTRACT (full text pdf. below)

Foot Web Free Flaps for Single-Stage Reconstruction of Hand Webs

Purpose To present a method for reconstructing the digital web in posttraumatic defects using a free tissue transfer of the web from the foot and to present the functional and aesthetic results.

Methods Nine web free flaps were performed; 8 were used to reconstruct posttraumatic web losses and 1 was used to reconstruct a defect resulting from to infection. All cases involved the first (3) or second (6) webs of the hand. Web flaps were taken from the foot first web (2 patients), from the second (6 cases), and from the third (1 case) in a patient with congenital syndactyly of second foot web space. The donor site was managed by skin grafting from the instep (1 case), creation of a syndactyly (7 cases), or both (1 case).

Results All flaps survived without complications. Finger abduction and flexion-extension were similar to the contralateral side. No functional limitations, pain, or contracture were reported. One donor site healed with hypertrophic scars; otherwise, no donor site complications occurred. On a visual analog scale (0e10), the patient assessed appearance of the hand and the donor foot as 9.0 and 9.0, respectively, on average. One web was not well-positioned in the first operation and required revision.

Conclusions The foot web free flap reconstructs the hand web by replacing it with a similar functional subunit rather than attempting to recreate the complex geometry, and allows for full function and excellent appearance of the hand.

Type of study/level of evidence Therapeutic IV.

Key words: Microsurgery, free flap, web reconstruction, crush, web flap.