Case 9: Adipofascial Turnover Flap for Reconstruction of a Dorsal Finger Defect Following SCC Excision

Keywords: Squamous cell carcinoma, adipofascial, turnover flap, finger, defect, reconstruction Authors: Lukas Kure-Rosenberg, MD Magnus Balslev Avnstorp, MD Nicco Krezdorn, MD, Chief. Institution: Department of Plastic Surgery, Zealand University Hospital, Denmark Abstract Reconstruction of finger defects presents unique challenges, particularly in those with complex anatomical involvement. We present a case involving an immunosuppressed patient with a larger late diagnosed SCC, the excision of- and subsequent reconstruction- utilizing an adipofascial turnover flap (APTF), that offers a reliable and versatile option for addressing these challenges, while preserving hand function and aesthetics. A 74-year-old male with a history of kidney transplantation and long-standing immunosuppressive therapy presented with a highly differentiated SCC on the dorsum of the right fourth finger. The lesion, measuring 40 × 35 mm, extended to the proximal and distal interphalangeal joints. Surgical management included two stages: tumor excision with clear margins, followed by secondary reconstruction utilizing an APTF combined with a split-thickness skin graft (STSG). Preoperative and perioperative Doppler assessments guided flap design and ensured adequate vascularity. The APTF provided robust soft-tissue coverage of the exposed extensor tendon, with adequate perfusion confirmed by Doppler. The STSG demonstrated partial take but effectively covered the underlying APTF. Postoperative assessments were followed 30, 48, and 106 days postoperatively. Range of motion (ROM) showed postoperatively some limitations in the affected finger, particularly in the PIP and DIP joints, but functionality was aimed preserved with ongoing therapy. We demonstrate in this clinical case, how APTF is an effective and versatile reconstructive option for complex dorsal finger defects. Its robust vascular supply, adaptability, and minimal donor site morbidity make it particularly advantageous in immunosuppres