One-stage reconstruction of dorsal hand soft-tissue defects with tendon allograft and free anterolateral thigh flaps

Abstract

Objectives To evaluate the clinical effect of one-stage reconstruction of dorsal hand softtissue defects using tendon allograft and free anterolateral thigh flaps.Methods From July 2006 to July 2011,fifteen cases of complex soft-tissue defects in dorsal hands were repaired using tendon allografts and anterolateral thigh flaps,sizing from 9 cm ×5 cm to 14 cm× 11 cm,in one stage.Two to 4 digital extensor tendons were reconstructed.With a brace on,early finger exercises were started after 2 weeks postoperatively when the flaps had survived.Results All the 15 flaps survived uneventfully.Twelve of the 15 patients were available for follow-up from 12-24 months (averaged 16 months).Two cases received tendolysis due to poor finger movement 6 moths postoperatively.At the end of follow-up,the range of wrist joint active flexion is from 40 to 70degrees and extension is from 25 to 50 degrees.The motion range of the related metacarpophalangeal joints was from 60 to 85 degrees,that of the interphalangeal joints from 80 to 90 degrees.The overall effective rate was 92 percent.Conclusion Simultaneous composite repair using tendon allografts and skin flaps proved to be reliable and cost-effective for complex dorsal hand soft-tissue defects.Allograft tendon reconstruction can not only obliterates new morbidities of autografting but also facilitates timely rehabilitation,avoiding extension loss of hand joints. Key words: Anterolateral thigh flap; Tendon allograft; Dorsal hand; Microsurgery