Free poly‑foliate flap for one‑stage reconstruction of multiple finger skin defects: A reconstructive concept and 39 cases from five donor sites.

Abstract

Multiple finger skin defects with exposed bone or tendon are challenging to reconstruct while preserving finger independence. Traditional approaches require multiple operations, secondary finger separation, or multiple vascular anastomoses. We systematically evaluated the use of free poly-foliate perforator flaps for one-stage reconstruction of multiple finger defects and report the largest focused case series to date. Thirty-nine patients (27 men, 12 women; mean age 36.6 years) with multiple finger skin defects underwent reconstruction using free poly-foliate perforator flaps from five donor sites: posterior interosseous artery (n=17), radial collateral artery (n=8), dorsalis pedis artery (DPA, n=6), anterolateral thigh (n=1), circumflex scapular artery (n=3), and combined flaps (n=4). Flaps were designed with 2-4 foliates based on preoperative Doppler localization. Only one set of vascular anastomoses was performed per patient. Most donor sites were closed primarily except for DPA flaps, which required skin grafting; all donor sites healed without functional impairment. Overall, 100 foliates from 46 flaps were transferred. Complete flap survival was achieved in 36 patients; only 3 patients experienced necrosis of a single foliate. Most donor sites closed primarily except for DPA flaps, which required skin grafting. No iatrogenic syndactyly or secondary finger separation was needed. At the final follow-up, excellent-to-good functional outcomes were obtained in 92.3% of the patients. Free poly-foliate perforator flaps enable single-stage, independent reconstruction of multiple finger skin defects with high flap survival, low donor-site morbidity, and avoidance of secondary procedures.