Sir:
We have read the article published by Lee et al.1
The reconstructive decision after digit soft-tissue wide excision can be extremely challenging, considering the size and site of the defect and the need for thin, pliable soft-tissue coverage. Full-thickness skin grafts are not considered the gold standard, as they cannot provide a satisfactory reconstruction (especially when bone tissue has to be covered) or a sensate reconstruction, and thus many techniques have been described and explored.2 3
Improvements in microsurgical techniques have made tailored reconstructive options more obtainable. Free tissue transfers are indicated when one phalanx or more tissue is involved or when more than half of the phalangeal circumference needs to be covered. The superthin superficial circumflex iliac artery perforator flap has proven to represent a valid option in digit reconstruction; however, the need for intraoperative or postoperative defatting and its unfeasibility under single-block anesthesia make other surgical options worth considering (Fig. 1 ).
Fig. 1.: Immediate preoperative photograph of a fifth finger defect, with the ulnar perforator flap marked.
Because of our experience, we believe that the ulnar artery perforator free flap could be considered a valid reconstructive option in view of the fact that it can be harvested under brachial plexus block when harvested ipsilateral to the defect; it can provide thin, soft, pliable fasciocutaneous or cutaneous tissue that does not require a further surgical procedure (i.e., trimming of the flap itself, which can lead to flap perfusion compromise); and it often allows direct closure of the donor site with minimal morbidity. In addition, the donor area is typically hairless, the skin texture might be considered similar to that of the digital skin, the vascular anatomy is reliable, the ulnar neurovascular bundle is preserved, and it can be harvested as a sensate flap, gaining a satisfactory functional and aesthetic result4 , 5 Fig. 2 ).
Fig. 2.: Postoperative results after 6 months.
DISCLOSURE
The authors have no conflicts of interest to report in relation to the content of this communication.
Mario Cherubino, M.D.
Chiara Stocco, M.D.
Davide Sallam, M.D. Luigi Valdatta, M.D.
REFERENCES
1. Lee KT, Park BY, Kim EJ, et al. Superthin SCIP flap for reconstruction of subungual melanoma: Aesthetic functional surgery. Plast Reconstr Surg. 2017;140:12781289.
2. Chen X, Chen H, Zhang G. Management of wounds with exposed bone structures using an artificial dermis and skin grafting technique. J Plast Reconstr Aesthet Surg. 2010;63:e512e518.
3. Quaba AA, Davison PM. The distally-based dorsal hand flap. Br J Plast Surg. 1990;43:2839.
4. Cherubino M, Corno M, Valdatta L, Adani R. Thumb reconstruction with thin proximal ulnar perforator free flap. J Hand Surg Am. 2017;42:e133e138.
5. Xiao C, Bao Q, Wang T, Peng F, Gu Y. Clinical application and outcome of the free ulnar artery perforator flap for soft-tissue reconstruction of fingers in five patients. Plast Reconstr Surg. 2013;131:132e133e.
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