Plastic Replacement of Palmar Defects

Abstract

Material and Methods. The authors have developed a two-step method of plastic substitution of the palmar defect, which had consisted in the preliminary preparation of the tissue complex on the own fascia of the forearm and then transposition it to the hand as island flap on the radial vascular bundle after the excision of the scar and eliminate flexion contractures of the fingers. According to the proposed method, 7 patients with vicious scars of the palmar surface of the hand and flexion contracture of the fingers were operated. Males prevailed, the mean age of patients was 39±12.4 years. In 5 cases, the cause of scar contracture of the hand was an open trauma with a tissue defect, in other cases, contact bum. Results. Patients were examined in 3,6 and 12 months. The complication was noted in one case, which was a partial necrosis of the skin part of the flap, which required additional plasty with a split skin graft, which did not affect the final result. The flaps were stable and resistant to mechanical stress, no correction was required in any case. By 6 months protective sensibility in the hand recovered in all cases. Conclusion. The described method of substitution of extensive deep palmar defects can be applied after correction of scar deformation and elimination of flexion contracture of fingers. Prelamination provides reliable engraftment of a full-layer or thick split skin graft taken from any area of the human body. Strong fixation of the skin graft to the fascia provides a small displacement of the skin and and the lack of excess tissue. The flap is resistant to mechanical stress and provides restoration of protective sensitivity. The damage to the donor area is insignificant, as the scar on the forearm remains hardly noticeable. The disadvantages of the proposed method include the need to perform two surgical interventions.