Clinical Report: Utilizing a perforator-based axial adipofascial turnover flap

Background

Hand trauma accounts for a significant proportion of emergency department visits, with complex injuries requiring careful reconstruction to prevent long-term disability. The reconstructive ladder principle guides the selection of surgical techniques, emphasizing the need for effective yet straightforward approaches. This study addresses the challenges of reconstructing dorsal finger defects, particularly when critical structures are exposed.

Data Highlights

This study is a retrospective case series assessing patients from 2012 to 2020 with acute traumatic dorsal digital defects. Specific numerical data were not provided in the source material.

Key Findings

• The protocol includes interphalangeal joint stabilization, juncturae tendinum grafting, and soft-tissue coverage with an adipofascial flap.
• Local soft-tissue coverage is essential for managing defects involving bone, tendon, or joint exposure.
• Individualized planning is necessary to balance reliability, morbidity, and technical requirements in reconstruction.
• The adipofascial flap is characterized as axial-pattern, relying on dorsal cutaneous branches for vascularity.
• Type 3 juncturae tendinum are utilized for tendon reconstruction in the fourth intermetacarpal space.

Clinical Implications

Surgeons may consider this protocol as a feasible option for complex dorsal finger reconstructions, emphasizing the importance of local tissue utilization. The approach aims to minimize procedural complexity while ensuring effective coverage and functional restoration.

Conclusion

The presented method offers a practical solution for complex dorsal finger injuries, combining soft-tissue coverage and tendon reconstruction in a single stage. This approach may enhance surgical outcomes in hand trauma management.

Related Resources & Content

1. Braga-Silva et al., 2020 -- Characterization of the adipofascial arterial turnover flap
2. BJS, 2025 -- Reconstructive Approaches for Advanced Pelvic Cancers
3. Frontiers in Surgery, 2026 -- Surgical Repair of Combined Bone and Soft Tissue Defects
4. PMC, 2025 -- Considerations in Flap Selection for Soft Tissue Coverage
5. PubMed, 2025 -- A 25-Year Systematic Review of Flaps for Coverage of the Dorsal Hand
6. Reconstruction of the Thumb Following Radical Tumor Resection Utilizing a Free Osteocutaneous Lateral Arm Flap with Subsequent Humerus Fracture: A Case Study
7. BSSH Standards of Care in Hand Trauma
8. Considerations in Flap Selection for Soft Tissue Coverage of the Hand and Digits - PMC
9. A 25-Year Systematic Review of Flaps for Coverage of the Dorsal Hand - PubMed