Anatomical Study and Clinical Application of the Pedicled Distal Palm Mini- kiss Flap

Objective To further clarify the anatomical basis and clinical applications of the pedicled distal palm mini-kiss flap for reconstructing traumatic soft tissue defects in distal fingers. Methods A total of 20 cadaveric hand specimens were dissected to classify three distinct neurovascular anatomical types. Between 2008 and 2024, 18 distal finger defects in patients were reconstructed with the sensate pedicled distal palm mini-kiss flap. Patient demographics, injury details, defect information, defect dimensions and anatomical location, sources of pedicle vessels, donor and recipient nerve branches used for innervation, as well as clinical outcomes during follow-up were recorded. Results Three anatomical neurovascular subtypes were found. The distances between the two cutaneous flap branches ranged from 4 to 10 mm. A total of 18 distal finger defects were reconstructed using 10 oblique flaps and 8 transverse pedicled distal palm mini-kiss flaps. The mean area of soft tissue defect was quantified at 5.76 ± 2.31cm ² . Nerve coaptation was achieved in 16 cases. Donor sites had no major complications, and only 2 cases had small blisters measuring between 1-2mm that resulted in epidermolysis at the distal edge of the flaps. The average follow-up was 14 months, and the two-point discrimination tests indicated an average measurement of (5.9 ± 0.7) mm. Conclusion The pedicled distal palm mini-kiss flap has been proven to be an effective and safe option for reconstructing defects of the distal finger. The classification system and technical considerations enhance its potential for this reconstructive approach to achieve optimal functional and aesthetic outcomes. Type of study/ level of evidence Level IV, retrospective case series