• Gan-lin Zhang, Hong Meng, Jian-Hua Huang, Xiao-Fang Hong, Hua-Sheng Zhang, Xiao-Tao Liu, He-Yuan Luo, and Wei-Yong Liu.
• Department of Plastic and Traumatic Surgery, HuiZhou Affiliated Hospital, Sun Yat-sen University (HuiZhou Municipal Central Hospital), HuiZhou, China.
• J Reconstr Microsurg. 2015 Jul 1; 31 (6): 471-6.

BackgroundSoft-tissue digital defects frequently need to be covered by a flap rather than a skin graft. In hand surgery, functional preservation and aesthetic appearance are often as important as procedural efficacy.ObjectiveWe present our clinical experience with reconstruction of digital skin defects with the free wrist crease flap.MethodsFrom January 2012 to September 2013, 14 digits of 14 patients (10 males, 4 females) were included for evaluation. The procedure was performed with brachial plexus block anesthesia. The superficial palmar branch of the radial artery, a subcutaneous superficial vein, and the palmar cutaneous branch of the median nerve were included in the free wrist crease flap. The flaps were used to reconstruct the skin defect of injured digits through microvascular anastomosis, and donor sites were closed primarily.ResultsPostoperative follow-up time ranged from 3 to 25 months. All digital deformities were corrected, all flaps survived completely without ischemia, and none were aesthetically bulky. The area of free wrist crease flaps ranged from 2.5 to 5.0 cm by 2.0 to 3.1 cm. Slight wound infections appeared in two cases. Venous crisis occurred in one case, but it was successfully addressed after vascular exploration and reanastomosis. Sensation determined by static two-point discrimination measured in these flaps 2 months postsurgery was "good" at a mean 9.7 ± 2.1 mm (range, 6-14 mm). The mean motion range of the distal interphalangeal joint and proximal interphalangeal joint was 23.4 ± 6.9 degrees (0-42 degrees) and 75.8 ± 22.1 degrees (0-98 degrees) preoperatively. The mean motion range of the distal interphalangeal joint recovered to 40.3 ± 5.7 degrees (36-42 degrees), and that of the proximal interphalangeal joint was 90.3 ± 15.3 degrees (85-98 degrees) postoperatively. Both joints reached normal motion angle and difference was statistically significant preoperatively and postoperatively (p < 0.05). The mean disabilities of arm and shoulder (DASH) score was 6.8 ± 3.4 (0-15), and there was statistically significant difference when compared with the preoperative score of 13.5 ± 4.3 (3-19) (p < 0.05).ConclusionWe found the free wrist crease flap to be an ideal solution for reconstruction of skin defects of digits.Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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