Treatment of avulsion injury of three fingers with a compound thoracodorsal artery perforator flap including serratus anterior fascia.

Complete degloving injury of three digits not amenable to revascularization may leave poor cosmetic and functional results. We used a compound thoracodorsal artery perforator (TDAP) flap in a 34-year-old, right-handed, male worker with traumatic degloving injury. The flap consisted of a thin nonbulky skin component isolated on two perforators in combination with serratus fascia, both pedicled on the thoracodorsal vessels. The mobility of the two flap components allowed the palmar and dorsal part of the fingers to be reconstructed without relying on multiple flaps or anastomoses. The skin component of the TDAP flap was transferred to the palmar defect, the serratus fascia flap to the dorsal part of the fingers and sutured loosely. Coverage of the serratus anterior fascia was done with split-thickness skin graft. Both components of the flap survived completely. One month after the first operation, the surgical syndactyly between middle and ring finger was separated, one month later the syndactyly between the ring and little finger. Good coverage of the soft tissue defects with good function could be achieved. There were no donor-site problems. Therefore, we consider the compound TDAP flap as a useful method that provides functional and cosmeticcoverage of severe avulsion injury of multiple digits. (c) 2009 Wiley-Liss, Inc. Microsurgery, 2009.