Oblique Axis Hypothenar Free Flaps: Tips for Harvesting Larger Flaps with Minimal Donor Site Morbidity

Abstract

Background Hypothenar free flaps (HTFFs) have been widely used for reconstructing palmar defects. Although previous anatomical and clinical studies of HTFF have been conducted, this technique still has some limitations. In this study, we describe some tips for large flap design that allows for easy harvesting of HTFFs with minimal donor site morbidity.

Methods A total of 14 HTFF for hand defect reconstruction were recorded. The oblique flap was designed in the proximal HT area following relaxed skin tension line along the axis between fourth web space and 10 mm ulnar side of pisiform. A flap pedicle includes one or two perforators with ulnar digital artery and HT branch of basilic vein. In addition, innervated HTFF can be harvested with a branch of ulnar digital nerve. Electronic medical records were reviewed to obtain data on patients' information, operative details, and follow-up period. In addition, surgical outcome score was obtained from the patient, up to 10 points, at the last follow-up.

Results Mean harvest time was 46 minutes, and two perforators were included in 10 cases. The mean flap area was 10.84 cm². There were no problems such as donor site depression, scar contracture, keloids, wound dehiscence, numbness or neuroma pain at donor sites, and hypersensitivity or cold intolerance at flap site, either functionally or aesthetically.

Conclusion Palmar defect reconstruction is challenging for hand surgeons. However, large HTFF can be harvested without complications using the oblique axis HTFF technique. We believe our surgical tips increase utility of HTFF for palmar defect reconstruction.

Keywords

fingertip reconstruction - flap design - hypothenar free flap - perforator flaps - soft tissue reconstruction

Authors' Contributions

S.H.O.: conceptualization, data curation, visualization, writing the original draft and review, and editing manuscript. J.I.C.: writing manuscript and review and editing.

Ethical Approval

This study was approved by the institutional review board of Korea National Institute for Bioethics Policy (IRB no.: KoNIBP P01-202112-21-022).

Patient Consent

The patient provided written informed consent for the publication and using images.

Financial Disclosure Statement

The authors have no proprietary or commercial interests in any of the materials discussed in this article.

Publikationsverlauf

Eingereicht: 22. Juli 2022

Angenommen: 28. Dezember 2022

Accepted Manuscript online:
06. Januar 2023

Artikel online veröffentlicht:
29. Mai 2023

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