Soft tissue reconstruction with small free flaps in hand and finger defects

Background With the technological and technical improvements in microsurgery, the defect reconstruction with free flaps has increased in hand surgery. In this study, we aimed to evaluate the results of free posterior interosseous perforator (PIAP) flap, free superficial palmar branch of the radial artery (SUPBRA) flap and hypothenar free perforator flap in hand and finger defects. Methods A total of 58 patients who were operated between 2017 and 2021 were included in the study. Hand defects of patients occurred due to industrial accidents and reconstructed by using free SUPBRA, free PIAP and hypothenar free perforator flaps were included into the study. Demographics of patients, characteristics of the flaps and complications were evaluated retrospectively. Results Twenty eight free SUPBRA flap, 12 hypothenar free perforator flap and 18 free PIAP flap surgeries were performed. Static and dynamic two-point discrimination tests were evaluated and acceptable results were obtained. Donor site scar was compared with the non-operated side by using visual analogue scale (VAS). The median VAS values were calculated as 8 for three different flaps. Total necrosis developed in 3 patients. Other complications are hematoma, partial necrosis and wound dehiscence in the donor area. Conclusion We obtained good aesthetic and functional results by using free small flaps in hand and finger defects. As the experience of perforator-to-perforator anastomosis increases, the use of these flaps in the reconstruction of hand defects is increasing. Level of evidence: Level III, Therapeutic.