Random-pattern Abdominal Flap Research Articles

Extensor Tendon and Coverage Reconstruction of Soft Tissue Defect in a Case of Trauma to Dorsal Hand

: A case of soft tissue defect of dorsal hand due to crush injury in a 37-year-old female is reported here. The reconstructive surgery was performed for the hand soft-tissue defect. Among different flaps used in the surgery, the regional flap such as radial forearm flap can be done. But usually it is not accepted by patient because of cosmetic appearance. Therefore, random pattern abdominal flap and extensor tendon reconstruction were done concurrently.

Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects.

Background:Fingertip defect can be treated with many flaps such as random pattern abdominal flap, retrograde digital artery island flap, V-Y advancement flap, etc. However, swelling in the fingertip, dysfunction of sensation, flexion and extension contracture or injury in the hemi-artery of the finger usually occurs during the recovery phase. Recently, digital artery perforator flaps have been used for fingertip reconstructions. With the development of super microsurgery techniques, free flaps can be more effective for sensory recovery and durability of the fingertip.Materials and Methods:Six cases (six fingers) of fingertip defects were treated with free digital artery perforator flaps of appropriate size and shape from the proximal phalanx. During surgery, the superficial veins at the edge of flap were used as reflux vessels and the branches of the intrinsic nerve and dorsal digital nerve toward the flap were used as sensory nerves. The proximal segment of the digital artery (cutaneous branches) towards the flap was cut off to form the pedicled free flap. The fingertips were reconstructed with the free flap by anastomosing the cutaneous branches of digital artery in the flap with the distal branch or trunk of the digital artery, the flap nerve with the nerve stump and the veins of the flap with the digital artery accompanying veins or the superficial veins in the recipient site.Results:Six flaps survived with successful skin grafting. Patients were followed up for 6-9 months. The appearance and texture of the flaps was satisfactory. The feeling within the six fingers recovered to S4 level (BMRC scale) and the two point discrimination was 3-8 mm.Conclusion:Free digital artery perforator flap is suitable for repairing fingertip defect, with good texture, fine fingertip sensation and without sacrificing the branch of the digital artery or nerve.

Effects of Aesthetic Abdominoplasty on Abdominal Wall Perfusion: A Quantitative Evaluation

Abdominoplasty procedures involve a high risk of early complications, including hematomas, seromas, necrosis, and wound-healing problems. Their rationale is evident from the vascular anatomy of the abdominal wall, as traditional abdominoplasty includes a division of the main perforating vessels. No studies exist to quantitatively assess the consequences of abdominoplasty on the perfusion of the random pattern abdominal flap. To address this issue and quantify the influence of classic abdominoplasty on the perfusion of the abdominal skin, the authors performed a prospective clinical trial including 15 low-risk patients undergoing abdominoplasty for aesthetic purposes. Perfusion of the abdominal flap was measured intraoperatively using the technique of dynamic laser-fluorescence-videoangiography. In the region between the umbilicus and the transverse scar (zone 1), the increment of fluorescence (the slope of the intensity curve during inflow of the indocyanine green) was recorded and compared with the intensity curve of normal tissue that was not involved in surgery (thoracic wall). The results of the intraoperative indocyanine green perfusography showed a significant impairment of the vascular supply of zone 1 in all patients. The mean perfusion index in this region was 17.2 percent (range, 5 to 32 percent) of the perfusion of the surrounding skin that was not involved in surgery. The complication rate was 33 percent (five patients) and included two cases of hematoma and three cases of scar dehiscence with skin and/or fat necrosis. These data indicate that conventional abdominoplasty including extended undermining and division of the superficial and the deep arterial systems causes profound devascularization of the abdominal flap. This might explain the high incidence of complications following this procedure.

The abdominal flap using scarred skin in the treatment of postburn hand deformities of severe burn patients

Purpose To present a random-pattern flap technique using scarred skin from the abdominal wall to cover the defect after burn scar was released from the hand and the scarred skin raised from the hand was transferred to the abdominal wall to cover the flap-donor area in patients who suffered from severe burns involving the entire body and had no available healthy skin to be used for coverage. Methods Ten hands of 7 patients (5 males, 2 females) were treated in our department between April 1994 and February 2001. The total body surface area involved with second-or third-degree burns was 85% to 96% and there was no available healthy skin to be used for reconstruction. All hands had severe scar contracture on the dorsum and lost most of their function and the patients lost the ability to take care of themselves. The scarred skin on the dorsum of the hand was elevated integrally as a flap based on the ulnar border of the hand. The tendons were released, the stiff metacarpophalangeal joints were mobilized by closed capsulotomies, and the contracture of the thumb web space was released. A random-pattern abdominal flap using scarred skin was designed and elevated to cover the defect of the scar-released hand and the scarred skin raised from the dorsum of the hand was transferred to cover the defect of the abdominal flap donor site. Results The flaps that were transferred to the dorsum of the hands survived entirely and the defects of the flap donor area were covered perfectly without further skin graft. All patients were evaluated for 0.5 to 4 years after surgery. The range of motion of the metacarpophalangeal joints and the space capacity of the thumb web were improved greatly. All patients regained the ability to take care of themselves. Conclusions This method is simple and has satisfactory results. It appears from our experience that the mature postburn scarred skin on the abdomen can be used for a flap procedure for reconstructing the burned hand and that the scarred skin raised from the dorsum of the hand can be transferred to cover the flap donor sites on the abdomen. Under circumstances in which there is no normal skin for reconstruction the function of the burned hand could be improved greatly by this method.

Scalp Reconstruction with a Prefabricated Abdominal Flap Carried by the Radial Artery

Custom prefabrication of free flaps provides an unlimited variety of applications, since flaps can be created with expendable tissues and without restriction to naturally occurring vascular territories. These principles also can be used to customize flaps that could not be completed by conventional means. We report a case of scalp reconstruction using a random-pattern abdominal flap in which a radial artery fascial flap was induced to serve as the vascular carrier. In addition to providing durable scalp coverage, the prefabricated free flap enabled salvage of an abdominal flap that would otherwise have been aborted after intermediate transfer to the forearm.

Preservation of function following complete degloving injuries to the hand: Use of simultaneous groin flap, random abdominal flap, and partial-thickness skin graft

Early total wound coverage is effectively achieved in complete degloving injuries to the hand and digits by preliminary skeletal narrowing and shortening, volar partial-thickness skin grafting, and application of a long, axial-pattern attached groin flap to the dorsum of the hand and remaining phalanges. If the thumb has been skeletonized by the initial trauma, simultaneous use of a circumferential random-pattern abdominal flap ensures complete coverage and earlier mobilization. THis combination of techniques is effective in preservation of pinch power and control, hook function of the medial portion of the hand, and general grasp and release attitudes.