Reconstruction of the Palmar Defect of the Hand with a Sensory Medial Plantar Artery Flap

Background: There are many approaches to repair the palmar defect of the hand, but due to the complex tissue structure, versatile functions, and high restoration demands, the repair of the palmar defect of the hand has always been a difficult task. Choosing suitable flaps to repair this kind of injury is always a tough challenge for the reconstructive surgeon because of the limitation of the number of arteries in the recipient hand and high restoration demands. The sensory medial plantar artery flap is considered as the ideal choice to repair the palmar defect of the hand. Based on this technique, in the current study, we used the free sensory medial plantar artery flap to reconstruct the palmar defect of the hand and obtained satisfactory results. The purpose of this study was to review the use of the sensory medial plantar artery flap for the reconstruction of the palmar defect of the hand. Method: From January 2019 to December 2020, nine patients with the palmar defect of the hand underwent extremity reconstruction by a sensory medial plantar artery flap. The indications for this surgery were that the palmar defect of the hand need to be reconstructed and both anterior and posterior tibial arteries should be free-flowing. Patients who had systemic diseases such as diabetes millitus, vascular diseases, heavy smoking histories, and injuries of the donor site were ruled out for the surgery. Results: Nine patients were successfully treated by using a sensory medial plantar artery flap, with a mean age of 39.44 (range 19-58) years. Five of the patients were male and the remaining four were female. Seven of them had a machine crush, and the other two suffered thermal injury. In all cases, reconstruction was performed during the second stage of treatment. All flaps survived completely, and all of the donor sites healed well in Stage 1, except for one case of ischaemic skin necrosis due to tight sutures, which healed after suture removal. Conclusion: Our experience showed that the free sensory medial plantar artery flap was an alternative for one-stage reconstruction of the soft-tissue defect in the palm of the hand. This flexible approach not only repaired the soft-tissue defect, but also offered a satisfactory recovery of the sensory of the palm with minimal donor site morbidity.