Comparison of the efficacy of medial tarsal venous flaps and traditional venous/arterial free flaps in the reconstruction of hand soft tissue defects: a new type of physiological flap.

Background: The treatment of hand soft tissue defects primarily relies on flap reconstruction. However, traditional venous/arterial free flaps have several disadvantages, including damage to the donor site, blood stasis, cyanosis, blister formation, and even necrosis. These issues can significantly affect patient recovery and outcomes. Therefore, there is a need for alternative approaches that minimize these complications and improve overall patient treatment.

Objectives: To compare the efficacy of medial tarsal free venous flaps and traditional venous/arterial free flaps in the reconstruction of hand soft tissue defects, by evaluating various clinical outcomes and patient recovery metrics.

Materials and methods: We screened 30 suitable patients with hand soft tissue defects and randomly assigned them to three groups. Patients in each group were transplanted with either medial tarsal free venous flaps or traditional arterial/venous free flaps to achieve coverage and reconstruction of the soft tissue defects. The results were compared and analyzed using the following metrics: operation time, complication rate, pain index, postoperative infection rate, and functional evaluations of both the donor and recipient areas.

Results: There was no significant difference in operation time between the medial tarsal free venous flaps and the traditional forearm free venous flaps. The operative time of both types of flaps above was shorter than that of the traditional fibular-side arterial flap of the hallux. The complication rate of the medial tarsal free venous flaps was comparable to that of the fibular-side arterial flaps from the great toes and significantly lower than that of the traditional forearm free venous flaps. In terms of pain, the pain index for the medial tarsal free venous flaps was significantly lower than that of the fibular-side arterial flap from the hallux and comparable to that of the forearm free venous flaps. Regarding postoperative infection rates, the forearm free venous flaps had the highest rate, while there was no significant difference between the medial tarsal free venous flaps and the fibular-side arterial flaps from the great toes. The functional recovery of the medial tarsal free venous flaps was outstanding in both the donor and recipient areas. There was no poor functional performance in the donor areas of the forearm free venous flaps or the recipient areas of the fibular-side arterial flaps of the halluces.

Conclusions: The medial tarsal free venous flaps effectively avoid the disadvantages of traditional venous and arterial free flaps, combining their advantages. This kind of flaps offer shorter operative times, and lower pain indices. They also provide excellent functional recovery in both donor and recipient areas. Thus, medial tarsal free venous flaps represent an ideal solution for reconstructing hand soft tissue defects.