Fillet Flap (Finger)
This chapter describes in detail the surgical steps for performing a fillet flap of a digit. Fillet flaps can be performed on essentially on any extremity and their appendages, and thus, this operative note may serve as a template/concept for improvisatio
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Jimmy H. Chim, Emily Ann Borsting, and Harvey W. Chim
Indications
Essential Steps
Extensive trauma to bone, nerves, or tendons rendering a digit functionally unsalvageable. A viable soft tissue flap is harvested from this traumatized digit to cover an adjacent defect utilizing a “spare parts” approach to reconstruction.
Preoperative Planning
Possible Complications 1. 2. 3. 4. 5.
Flap loss. Revision. Infection. Wound dehiscence. Hematoma.
J.H. Chim, M.D. • H.W. Chim, M.D. Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami, Jackson Memorial Hospitals, 1120 NW 14th Street, Miami, FL 33136, USA e-mail: [email protected] E.A. Borsting, B.S. (*) Department of Plastic Surgery, University of California, Irvine, Orange, CA, USA e-mail: [email protected]
1 . Preparation of wound bed. 2. Total excision of nail complex. 3. Careful dissection to preserve digital neurovascular bundles. 4. Hemostasis before flap inset to prevent postoperative hematoma formation.
Intraoperative Details 1. Debridement of flap recipient site. 2. Y-shaped incision over dorsum of the digit. 3. En bloc excision of the nail complex with periosteal dissection deep to the plane of the nail bed. 4. Raising of subcutaneous tissue flaps laterally on the proximal digit. 5. Extensor tendon mechanism elevation and transection on traction. 6. Skeletonization of phalanges. 7. Transection of flexor tendons and amputation of bony phalanx through the metacarpophalangeal joint. 8. Debridement of cartilaginous metacarpal head with rongeur forceps. 9. Securing of split Penrose drain in wound bed. 10. Proximal inversion and insetting of fillet flap to cover defect.
© Springer International Publishing Switzerland 2017 T.A. Tran et al. (eds.), Operative Dictations in Plastic and Reconstructive Surgery, DOI 10.1007/978-3-319-40631-2_108
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Postoperative Care
J.H. Chim et al.
midline along the remainder of the digit. After en bloc excision of the nail complex with periosteal 1. Close monitoring of flap for signs of venous dissection deep to the plane of the nail bed, subcutaneous tissue flaps were raised laterally on the and arterial insufficiency. proximal digit, exposing the extensor tendon mechanism. The extensor tendon mechanism was sharply elevated from the proximal, middle and Operative Dictation distal phalanxes and was transected proximally on Diagnosis: complex injury of dorsal hand and traction. Periosteal dissection was performed around each phalanx to skeletonize their bony fingers. architecture and affiliated flexor tendons for ampuProcedure: fillet flap coverage. tation. Care was taken to avoid dissection near the volar-lateral neurovascular bundles to preserve blood supply to the flap. The bony phalanx was Indication amputated through the metacarpophalangeal joint sharply along with the flexor tendons on traction, This is a ________ with extensive injury to the exposing the cartilaginous metacarpal head. This digit including tendon disruption and defect of the dorsal hand.
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