Specific complications associated with different types of intrinsic pedicle flaps of the hand

One hundred eight pedicle flaps intrinsic to the hand were performed in 98 male and 10 female patients averaging 36 years of age for digit-level trauma in 19 thumbs, 27 index, 50 long, 8 ring, and 4 small fingers. Specific flaps employed were 79 antegrade proper digital artery, 10 reverse proper digital artery, 6 reverse second dorsal metacarpal artery, 5 antegrade first dorsal metacarpal artery, 6 reverse dorsal ulnar artery of thumb, and 2 dorsal middle phalangeal flaps. The final average total active motion in the fingers was 235 degrees. Complications in 42 cases (39% actively smoking) included 10 partial flap losses, 13 cases of superficial epidermolysis, 4 cases of venous congestion, 4 superficial infections, 3 deep infections, and 8 cases of delayed healing at the wound margin. Second surgeries required were 3 debridements of deep wound infections, 3 revisions of the distal fingertip, and 9 full-thickness skin grafts. Specific associations of complications with flap type were between antegrade proper digital artery flaps and partial flap loss, epidermolysis, delayed wound healing, and infections at the distal margin but no cases of venous congestion. Reverse-flow flaps experienced venous congestion and epidermolysis but no partial flap losses or infection.