Littler Flap: A reliable option in soft tissue defects of different fingers

SUMMARY Objective: Finger soft tissue defects are common following trauma, burn, and contracture release. Heterodigital neurovascular island flap is one of the important flaps used for this purpose. However, it is generally used for the repair of pulp defects involving first finger, it is also useful for defects involving other fingers. In this study, we presented our clinical findings on the use of and outcomes associated with Littler flap in the reconstruction of soft tissue defects involving not only first finger, but also different fingers. Method: This descriptive study included 13 patients (9 males, 4 females) who were treated with a neurovascular island flap for different finger soft tissue defect between August 2012 and June 2014. Tissue defect was located the thumb in 4 patients, index finger in 4 patients, middle finger in 3 patients and ring finger in 2 patients. We evaluated sensibility and range of motion of the injured finger and donor finger. Results: In the study group, all flaps survived completely. At a mean follow-up of 12 months, the results of the donor and reconstructed fingers regarding range of motion showed that all patients achieved excellent or good results. The donor-site morbidity was accepted. The patients rarely complained of pain or the cold intolerance of the flap. Conclusions: The most important reason for the preference given to this flap in the reconstruction of finger defects is a reliable option due to constant pedicle for flap viability, single stage procedure, early mobilization of the hand, good functional and cosmetic result. Our opinion is that a littler flap should be used in different finger defects since it is highly useful and reliable in terms of flap complications and donor field morbidities. Keywords : finger injuries, island flaps , pedicled flap , soft tissue injuries OZET Amac: Travma, yanik ve kontraktur acilmasini takiben parmak yumusak doku defektleri siktir. Heterodijital norovaskuler ada flebi, bu amacla kullanilan onemli fleplerden biridir. Genellikle birinci parmak pulpa defektlerinin tamirinde kullanilmasina ragmen diger parmaklarda olusan defektleri icin de kullanisli bir secenektir. Bu calismada sadece 1.parmakta degil farkli parmak yumusak doku defektlerinin rekonstruksiyonunda littler flebi kullanimi ve sonuclari sunulmustur. Yontem: Bu tanimlayici calismada,  Agustos 2012- Haziran  2014 tarihleri arasinda norovaskuler ada flebi ile parmak yumusak doku defekti rekonstruksiyonu uygulanan 13 hasta (9 erkek, 4 kadin)  calismaya dahil edilmistir. Doku defekti, 4 hastanin basparmaginda, 4 hastanin isaret parmaginda, 3 hastanin orta parmaginda,  2 hastanin da yuzuk parmaginda yer almaktaydi. Donor ve yaralanan parmaklar, hareket acikligi ve duyu acisindan degerlendirildi. Bulgular: Bu calisma grubunda, fleplerin tamami yasadi. Ortalama 12 ay takipte, donor ve rekonstrukte edilen parmaklarin hareket acikligina gore sonuclari tum hastalarda mukemmel yada iyi olarak gosterildi. Donor saha morbiditesi kabul edilebilirdi. Hastalar, nadiren agri ve soguk intoleransindan yakinmaktaydi. Sonuc: Parmak defektlerinin rekonstruksiyonunda bu flebin tercih edilmesinin en onemli nedeni, flep yasayabilirligi icin sabit pedikulu olmasi, tek asamali prosedur olmasi, elin erken hareketi, iyi fonksiyonel ve kozmetik sonuc nedeniyle uygun bir secenektir. Bizim dusuncemiz, littler flep, donor saha morbiditesi ve flep komplikasyonlari acisindan son derece kullanisli ve uygun olmasindan dolayi, farkli parmak defektlerinde kullanilmalidir. Anahtar sozcukler : parmak yaralanmalari, pedikullu flep, yumusak doku yaralanmalari