Reconstruction of phalanx defects in three-joint hand fingers: cadaveric study justifying superior anatomy and aesthetics outcomes improving patient’s quality of life

Objective . The study objective is to analyze the anatomy of third-order vessels and surrounding tissues in each phalange of the three-joint fingers of the hand with the aim to assess prospects, as well as functional and aesthetic outcomes of soft tissue flap reconstruction of distal phalanx defects. Methods . The study considered anthropometric and experimental modeling of various axial flap techniques for finger defect reconstruction. Cadaveric studies on the right and left middle and ring fingers from male and female cadavers were done. Measurements included finger length, phalangeal lengths, and finger circumference. Additionally, the vascular structures, paratenon, tendons and ligaments, including triangular ligaments were examined. The following types of soft tissue reconstruction of distal phalanx defects were used: 1) axial flap harvested from the lateral finger surface; 2) cross finger axial flap of the adjacent finger; 3) modified cross finger axial flap from the adjacent finger. Results and discussion . Our cadaveric study provided new insights into finger tissue morphology, including blood supply of the skin and subcutaneous tissues. The findings revealed that the terminal branches of third-order vessels form a horizontal vascular network responsible for blood supply to the skin and therefore critical for axial flap survival in finger stump defect reconstruction. The obtained cadaveric findings on finger anatomy and blood supply parameters enabled the development of multiple options for autologous axial flap surgery in finder defect reconstruction. These techniques ensure successful surgery outcomes in patients with distal phalanx covering tissue defects of the three-joint fingers. The procedures allowed to achieve good aesthetics of phalanx elongation at the treatment final stage. Conclusion . The cadaveric modeling allowed to elaborate practical recommendations on flap harvesting in order to ensure sustainable blood supply. Various flap transfer and fixation techniques were refined to maximize treatment efficiency in terms of finger anatomy and aesthetic appearance.