Superficial Palmar Branch of the Radial Artery, Medial Plantar Artery Perforator, and Medial Sural Artery Perforator Free Flaps in Digital Soft Tissue Reconstruction: Comparisons of Clinical Outcomes From a Retrospective Institutional Series.

摘要

INTRODUCTION: Digital defects requiring soft tissue reconstruction are still challenging. There is no first-choice free flap for digital reconstruction, although various free flaps were used to reconstruct the defects to provide functional and aesthetically acceptable results. The aim of this study is to evaluate the functional, aesthetic, and sensory results of medial sural artery perforator, medial plantar artery perforator, and superficial palmar branch radial artery free flap techniques in digital tissue defects. PATIENTS AND METHODS: This retrospective institutional study was conducted in accordance with the STROBE guidelines. Between 2022 and 2023, 28 patients underwent free tissue transfer for their digital soft tissue defects, which were reconstructed with MSAP, MPAP, and SPBRA flaps. The age, sex, etiology of the trauma, and the defect size were noted. The flaps' sizes, recipient vessels, donor site complications, and follow-up durations were also documented. Patient and observer scar assessment scale (POSAS) was used to assess aesthetic satisfaction. To evaluate the functional results, Sollerman hand function test (SHFT) was used. To determine the sensorial improvements, static-2PD test and Cold intolerance scoring scale (CISS) were applied. RESULTS: The average ages of the patients were 42.3 ± 13.1, 44.4 ± 14, and 42.5 ± 13.9, respectively. The tests were administered to the patients at an average of 25.3 ± 2.3 months. According to the POSAS scores, patients reported the SPBRA flap to be more comfortable and aesthetically acceptable, and the MSAP flap was associated with drawbacks such as increased thickness and surface irregularity. SHFT scores were comparable among groups (MSAP: 70.56 ± 7.60, MPAP: 70.22 ± 6.61, SPBRA: 71.40 ± 4.67; p > 0.05). The 2PD test showed significantly better results in SPBRA (8.10 ± 1.20) compared to MPAP (11.78 ± 1.39) and MSAP (15.00 ± 2.18) (p < 0.05). CISS scores were significantly higher in SPBRA (48 ± 10.97) than in MPAP (19.56 ± 13.07) and MSAP (15.00 ± 12.58) (p < 0.05). As a result of the correlation analysis, a statistically significant and moderately negative relationship was found between the 2PD and CISS scores (r = -0.536, p = 0.003). CONCLUSION: The flaps showed relative strengths depending on the parameters evaluated. Therefore, it is not possible to identify a single flap as the definitive first-choice option.