Reconstruction Of Soft Tissue Defects Research Articles

Biodegradable temporising matrix in severe meningococcal septicaemia: a case report

Expanding experience with NovoSorb Biodegradable Temporising Matrix™ (BTM, PolyNovo Biomaterials Pty Ltd, Port Melbourne, Victoria, Australia) for complex wounds encouraged its use in the following case, which required reconstruction of extensive soft-tissue defects with exposed bone resulting from the sequelae of meningococcal B infection with septic shock and disseminated intravascular coagulation.

Free radial artery forearm flap reconstruction of forehead defect in a 2-year-old child

Reconstruction of soft tissue defect with exposed bone over the forehead is a technical challenge in pediatric population. The options vary from skin grafting, local flaps to complex microvascular tissue transfer. The local flaps leave unsightly scar in the neighboring area and may violate the hair bearing scalp, hair line and the direction of hair. Skin grafting requires a vascular bed for its take and the aesthetic appearance is inferior. The tissue expansion in an acute stage may not be an option. Here we present our experience of soft tissue reconstruction of a forehead defect in a 2-year-old child with free radial forearm flap (RAFF). To best of our knowledge free radial forearm flap has rarely been reported for usage in reconstruction of forehead defect in pediatric population.

Flap design and preliminary clinical experience of the lower trapezius musculocutaneous flap carrying a portion of the latissimus dorsi muscle

To explore the reliability and effectiveness of soft tissue defect reconstruction using the lower trapezius musculocutaneous flap carrying a portion of the latissimus dorsi muscle. Between December 2014 and December 2019, 13 patients underwent the reconstruction of soft tissue defects in various sites using the lower trapezius musculocutaneous flap carrying a portion of the latissimus dorsi muscle. There were 10 males and 3 females, with an average age of 52.1 years (range, 29-83 years). Twelve wounds were resulted from resection of various malignant tumor, including 6 cases of head and neck tumors, 5 cases of shoulder and back tumors, 1 case of chest and back tumors. Among the 12 cases, 4 cases were complicated with wound infection and bone exposure, 1 case with skull defect and cerebral dura exposure, and 1 case with wound infection, skull necrosis, and cerebrospinal fluid leakage. One case was injured in a traffic accident, which resulted in infection wound in the back and shoulder and bone exposure. The sizes of the defect and musculocutaneous flap ranged from 11 cm×7 cm to 23 cm×15 cm and 25 cm×8 cm to 40 cm×14 cm, respectively. According to the spatial relationship between the donor and recipient sites, propeller flaps (8 cases) or percutaneous tunnel island flaps (5 cases) were used to transfer the myocutaneous flap to the recipient area to repair the wound. The donor site was directly closed and sutured in 9 cases, and those with excessive tension were repaired with free skin grafts in 2 cases or transferred flaps in 2 cases. After the operation, necrosis of the distal 4-cm of the musculocutaneous flap occurred in 2 cases. After debridement, the resultant wounds were reconstructed using a local flap and a posterior intercostal artery perforator flap, respectively. The remaining 11 myocutaneous flaps survived completely without arteries and veins crisis. The wounds in the donor and recipient areas healed by first intention. All the patients were followed up 1 to 48 months (mean, 7.4 months). The color and texture of the flap were good. During the follow-up, 1 patient underwent tumor resection again due to tumor recurrence, and 1 patient with a scalp hemangiosarcoma died due to unexplained thoracic hemorrhage. Tumor recurrence was not found in the remaining patients. The musculocutaneous flap coverage was stable and the infection was controlled. The lower trapezius musculocutaneous flap carrying a portion of the latissimus dorsi muscle can be an alternation option to reconstruct refractory wounds with exposure of vital structures and organs and infection.

'Fat chance': a review of adipose tissue engineering and its role in plastic and reconstructive surgery.

Soft tissue reconstruction remains a continuing challenge for plastic and reconstructive surgeons. Standard methods of reconstruction such as local tissue transfer and free autologous tissue transfer are successful in addressing soft tissue cover, yet they do not come without the additional morbidity of donor sites. Autologous fat transfer has been used in reconstruction of soft tissue defects in different branches of plastic surgery, specifically breast and facial defect reconstruction, while further maintaining a role in body contouring procedures. Current autologous fat transfer techniques come with the drawbacks of donor-site morbidity and, more significantly, resorption of large amounts of fat. Advancement in tissue engineering has led to the use of engineered adipose tissue structures based on adipose-derived stem cells. This enables a mechanically similar reconstruct that is abundantly available. Cosmetic and mechanical similarity with native tissue is the main clinical goal for engineered adipose tissue. Development of novel techniques in the availability of natural tissue is an exciting prospect; however, it is important to investigate the potential of cell sources and culture strategies for clinical applications. We review these techniques and their applications in plastic surgery.

Reconstruction of Soft Tissue Defects in the Hand with a Free Anterolateral Thigh Deep Fascia Flap.

ObjectiveTo report our experience in the reconstruction of soft tissue defects in the hand with a free anterolateral thigh deep fascia flap and describe the clinical outcomes.MethodsThis study was a retrospective trial. From November 2016 to January 2020, six patients (four men and two women) with soft tissue defects in the hand were included in this study. The average age of the patients was 33.7 ± 12.7 years (range, 20 to 50 years). All patients underwent reconstructions with free anterolateral thigh deep fascia flaps. Relevant clinical characteristics were recorded prior to surgery. The size and thickness of the deep fascia flap and the thickness of the skin were measured intraoperatively. The survival of the flaps and skin grafts and the occurrence of infection were recorded after the operation. At follow‐up, donor site complications and postoperative effects were evaluated according to the outcome satisfaction scale. The pain in the injured hand was assessed using the visual analog scale.ResultsThe average body mass index (BMI) was 26.6 ± 1.7 kg/m2 (range, 23.9 to 28.7 kg/m2). The defect sizes ranged from 5 cm × 5 cm to 13 cm × 8 cm (average, 53.1 ± 27.9 cm2). The six anterolateral thigh deep fascia flaps ranged from 7 cm × 6 cm to 14 cm × 9 cm in size (average, 71.8 ± 29.1 cm2). The thicknesses of skin ranged from 25 mm to 40 mm (average, 32.5 ± 4.8 mm), and the thicknesses of the deep fascia flaps ranged from 2 mm to 3 mm (average, 2.5 ± 0.5 mm). After the operation, the blood supply of the deep fascia flap was normal in all cases. The second‐stage skin grafts of most patients survived completely. The skin graft in one case was partially necrotic and healed after a dressing change. No infection occurred. At follow‐up (average, 16.3 ± 6.9 months), there was only a linear scar and no loss of sensation at the donor site of each patient. According to the outcome satisfaction scale, the outcome satisfaction score ranged from 6 to 8 (average, 7.2 ± 0.9), all of which were satisfactory. Apart from one patient who reported mild pain, all the other patients reported no pain. Three typical cases are presented in this article.ConclusionsThe free anterolateral thigh deep fascia flap, which is suitable for reconstruction of soft tissue defects in the hand, can provide very good outcomes both functionally and aesthetically.

Free Flap Reconstruction of the Extremities in Patients Who are ≥65 Years Old: A Single-Center Retrospective 1-to-1 Matched Analysis.

PurposeDemographic changes are leading to population aging, and free flap reconstructions for various indications are expected to become increasingly common among older patients. Therefore, this study evaluated free flap reconstruction of the extremities in older patients and compared the outcomes to those from younger patients who underwent similar procedures during the same period.Patients and MethodsThis single-center retrospective study used a case-control design to compare older and younger patients who underwent free flap reconstruction of soft tissue defects in the extremities. One-to-one matching was performed for older patients (≥65 years) and younger patients (≤64 years) according to indication, flap recipient site, and flap type. The parameters of interest were clinico-demographic characteristics, flap type, defect location, indication for free flap reconstruction, number of venous anastomoses, and postoperative complications (flap loss, infection, and wound healing disorders).ResultsThe study included 48 older patients and 133 younger patients, with a mean follow-up of 12 months after discharge. The free flap reconstruction was performed at a mean interval of 19.8±22.8 days (range: 0–88 days). The 1:1 matching created 38 pairs of patients, which revealed no significant differences in the rates of flap necrosis and flap failure.ConclusionThis study failed to detect a significant age-related difference in the flap necrosis rate after free flap reconstruction of extremity defects. Therefore, with careful perioperative management and patient selection, microsurgical free flap reconstruction is a feasible option for older patients.

DIFFERENT SURGICAL OPTIONS IN MANAGEMENT OF LOWER THIRD LEG DEFECTS

Background: The reconstruction of traumatic soft tissue defects in the distal third of the leg is one of the most challenging problems in lower limb surgery. Among the most widely used techniques direct closure, skin grafting, local aps, pedicled ap and free ap are worthy of note. Usually, the low mobility of the surrounding skin does not make a direct closure possible. Aim: Different surgical options in management of lower third leg defects.Material and method: The study was conducted from JANUARY2018 to December 2019, in the Department of Plastic & Reconstructive Surgery Institute of Post Graduate Medical Education and Research (IPGME&R) and SSKM Hospital, KOLKATA. Result: 70 patients admitted to the Department of Plastic & Reconstructive Surgery and referred patients from Department of General Surgery &Orthopaedic Surgery, IPGME&R and SSKM Hospital, KOLKATA. We found that 30(42.9%) patients were female and 40(57.1%) patients were male. The mean age (mean± s.d.) of patients was 38.2286 ± 18.4651 years. Conclusion: Fasciocutaneous aps may represent a good alternative to the free aps in the areas were other local reconstructive procedures are not possible

Free Flap Reconstruction of Posterior Trunk Soft-Tissue Defects: Single-Institution Experience and Systematic Literature Review

The posterior trunk is a technically demanding location for microvascular free tissue transfer. In this study, the authors report their own institutional experience with soft-tissue free flap reconstruction of the posterior trunk and provide a systematic review of the literature regarding this uncommon clinical scenario. A systematic review was performed using the PubMed database in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A single-institution retrospective review was also performed including all patients who received a soft-tissue free flap for a posterior trunk defect between 1990 and 2019. The database search yielded 15 articles, representing 61 patients; the most commonly used flap was the latissimus dorsi (45.9 percent) and the most commonly reported defect location was the lumbosacrum (42.3 percent). Retrospective review of the authors' database identified 26 patients, with the latissimus dorsi being the most common flap and the sacrum the most common defect site. The authors' institutional case series showed a 30.7 percent major complication rate and 7.7 percent total flap loss rate; 38.4 percent of flaps required vein grafting. In this study, the authors provided a systematic literature review and described their own long-term institutional experience with these rare and difficult reconstructions. Although the overall complication rate is high, these reconstructions are frequently necessary, and an algorithmic approach can improve outcomes. Therapeutic, IV.

Reconstruction of Extensive Soft Tissue Defects of Lower Extremity With the Extended Anterolateral Thigh Flap.

The anterolateral thigh flap is a classic flap used for various reconstruction defects. However, the flap viability of extended large skin paddles (ie, 240 cm2) was doubted by many surgeons. This study reports successful experience of reconstructing extensive soft tissue defects of lower extremity using extended large skin paddles. Twelve consecutive patients who had undergone reconstruction of defects using an extended anterolateral thigh flap were identified. Patient characteristics (age, sex, defect location, injured structures, and type of flap) and outcome data were analyzed retrospectively. One artery and 2 accompanying veins were anastomosed to vascularize each flap. Follow-up periods ranged from 10 to 91 months postoperatively. The average size of the flaps was 268.75 cm2 (range = 220-391 cm2). All flaps were perforator flaps with one perforator except that 2 perforators were used in 3 patients. Two patients suffered partial flap necrosis of the distal portion with delayed healing. In conclusion, the extended anterolateral thigh flap is a considerable option for massive defects requiring composite tissue coverage. This flap is advantageous for reconstructing various complex defects in the lower extremities, providing a pliable and vascularized tissue to cover exposed extensive defects including tendons, nerves, and bones.

Non-radiation and non-drug–induced maxillary osteomyelitis: Study of underlying risk factors, presentation, management and treatment outcomes

BackgroundOsteomyelitis of the jawbone is mostly secondary to radiation exposure or bone remodelling drugs, with the mandible being commonly involved. Maxillary osteomyelitis risk is low owing to its high vascularity. This study was undertaken to evaluate risk factors, presentation, management and outcomes of maxillary osteomyelitis caused due to reasons other than irradiation and bone remodelling drugs. MethodsPatient records diagnosed with maxillary osteomyelitis were evaluated for demographic details, risk factors, clinical presentation, radiological features, treatment performed and outcomes. ResultsIn 38 patients with non-irradiated and non-drug–induced osteomyelitis, 13 involved the maxilla, seven were localized to the posterior maxilla and 10 showed paranasal sinus involvement. Dissemination to the cavernous sinus and cerebral spread was seen in one. Clinical findings included oroantral communication, pain and draining sinus. Imaging showed diffuse bone destruction areas with or without evidence of bony sequestrum. The most common systemic risk factor was diabetes mellitus. Maxillary osteomyelitis was associated with tooth extraction in eight cases. Surgical management included debridement, sequestrectomy, functional endoscopic sinus surgery, maxillectomy and reconstruction of soft tissue defect with local and regional flaps. Complete recovery was seen in 11 patients. Mortality was seen in two patients with mucormycosis having disseminated infection. ConclusionCompared with previous literature, a relatively higher ratio of maxillary involvement was reported. Diabetes mellitus was the most common risk factor, followed by osteopetrosis and tooth extraction. Osteomyelitis secondary to mucormycosis in immunocompetent patients was relatively localized and gave favourable response to management compared with patients with diabetes mellitus.

Anatomical Study of the Medialis Pedis Flap and its clinical applications in Asian Singaporean Patients

PurposeThe purpose of this study was to revisit the medial plantar artery's anatomy and study its distribution for raising the medialis pedis flap. Several investigators have reported their clinical experience with the use of this flap for reconstruction of soft tissue defects of the hand. However, many have reported difficulty raising the flap due to variations in its arterial anatomy and the confusion that exists with respect to the nomenclature in our literature. MethodsThis study was divided into 2 parts: an anatomic study and clinical application. In the anatomic study, 12 cadaveric feet specimens from 6 patients were injected with latex and barium-gelatin injections and the medial branch of the deep division of the medial plantar artery distribution was studied. We then described the use of a medialis pedis flap in four clinical cases to cover defects of the digits. ResultsThe anatomic study revealed that the average pedicle length of the deep division of the medial plantar artery was 1.94cm. In the four illustrative clinical cases where the flap was used, the average flap size was 4.5 × 3.75cm. Donor sites were either closed primarily or with skin grafts. The vessels used for this flap were the medial branch of the deep division of the medial plantar artery and venae commitantes, or subcutaneous veins which provided the superficial drainage. All flaps were successful without any significant complications. The study is novel in that it describes the anatomic variability of length of the medial branch of the deep division of the medial plantar artery that exits in nature. ConclusionsThis paper describes the medial branch of the deep division of the medial plantar artery and the anatomic variations that exist in the raising of the medialis pedis flap. We have shown how a medialis pedis flap is an ideal option for reconstructing soft tissue defects of the hand because of its texture, bulkiness and pliability in the context of like for like reconstruction.

Using Dorsal Metacarpal Artery Perforator Flap in the Soft Tissue Reconstruction of Traumatic Finger Defects: A Single-Center Study.

The reconstruction of soft tissue defects of fingers is a challenge due to the limitations of local tissue availability. The dorsal metacarpal artery perforator (DMAP) flap is a vascular island flap raised on the dorsum of the hand, and it is a good option for finger reconstruction by replacing similar-for-similar in a single operation. In this study, we would like to share our experience of using the DMAP flap in cases of various traumatic finger defects. From November 2016 to May 2019, patients who had traumatic finger injuries and had undergone DMAP flap for soft tissue reconstruction were examined. The patients' demographic data, injury and flap characteristics, wound healing status, and complications were collected and studied. The functional and aesthetic outcomes were evaluated using the Michigan Hand Outcomes Questionnaire. There was a total of 10 patients included in this study, of which 9 were male and 1 was female. The average age was 43 years (17-66 years). Seven patients were administered general anesthesia, and 3 others wide-awake local anesthesia. The average flap size was 4.9 × 2.0 cm, and all the donor sites were primarily closed. Nearly half of the patients had temporary venous congestion, but most of the flaps survived well ultimately. Only 1 patient had a partial flap necrosis, which required an additional skin graft. The DMAP flap offers a thin and pliable skin to reconstruct finger defects within 1-stage surgery. It is easy to harvest with reliable and constant circulation. With adequate design, the DMAP flap can be used to resurface both volar and dorsal finger defects and also can reach the tip of the little finger. The DMAP flap is the ideal flap for reconstruction of traumatic finger defect with either local or general anesthesia.

Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases

BackgroundLarge post-traumatic tibial bone defects combined with soft tissue defects are a common orthopedic clinical problem associated with poor outcomes when treated using traditional surgical methods. The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects.MethodsWe retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2–58 years). The mean defect of bone was 11.87 cm ± 2.78 cm (range, 8.2–18.2 cm) after radical resection performed by TFT. The soft tissue defects ranged from 7 cm × 8 cm to 24 cm × 12 cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification.ResultsThe mean duration of follow-up after frame removal was 32 months (range, 12–96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7–147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14–37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2–2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. Conclusion: TFT, in conjunction with soft tissue transport technique, can give good results in most patients (in this article, good and excellent results were observed in 64% of patients). Soft tissue transport is a feasible method in providing good soft tissue coverage on the bone ends. Although it has no advantages over microvascular techniques, it might be an good alternative in the absence of an experienced flap surgeon. Nonetheless, high-quality controlled studies are needed to assess its long-term safety and efficacy.

Free Gastric Flap for Oral Reconstruction-a Feasibility Study in Oral Defects.

Free flap transfer is a standard practice in reconstruction of oral defects. Fasciocutaneous flaps are commonly used for reconstruction of soft tissue defects. Replacement of oral mucosa with skin often causes discomfort, foreign body sensation, dysgeusia, problems with skin hair and morbidity at the donor site. Morbidity at the donor site may interfere with physical activity among manual labourers. We prospectively analysed nine cases of oral cavity defects reconstructed with free gastro-omental flap over 4 months from March to July 2019. A free gastric flap based on right and left gastric artery and vascular arcade was harvested from the body of stomach. Feasibility, technical aspects, advantages and disadvantages of the flap are reviewed. Flap survival was 100%. No re-exploration for salvage was required. Flap was monitored for viability by colour change and capillary refill. All the nine cases healed well. One patient required readmission for bleeding from the raw area exposed at the margins of the flap. Patient satisfaction and quality of life was satisfactory. Long pedicle length, rich submucosal vascular network, dual pedicles available for anastomosis, like to like mucosal tissue replacement and low donor site morbidity make it a reliable option in the armamentarium of oral reconstruction. Free gastro-omental flap is a feasible and reliable tissue available for reconstruction of oral soft tissue defects.

Thin submental artery perforator flap for upper lip reconstruction: A case report

Reconstruction of upper lip defects can be challenging even for experienced surgeons. In order to restore both function and morphology, the use of quality soft tissue is essential. To this effect, the most common solution is the use of local flaps, or, in extreme situations, a free flap. However, a thin cutaneous upper lip defect may require a different approach. Perforator flaps are versatile and may allow an efficient reconstruction of soft tissue defects using adjacent similar tissues, providing the benefit of "like with like" coverage. We present the case of a 41-year-old female with a 1 × 1.5 cm basal cell carcinoma of the right-side upper lip, initially treated with a full thickness skin graft. Due to poor aesthetic and functional result, a thin submental artery perforator (SMAP) flap reconstruction was performed. Flaps' dimensions were 6 cm long and 4 cm wide and it was based on a perforator arising from the submental artery. Dissection was conducted above the platysma muscle, and the SMAP flap was transferred into the defect through a subcutaneous tunnel created below the mandible and posterior to the anterior belly of digastric muscle. The pedicle length of 6.5 cm was adequate for a tension free inset of the flap. Postoperative course was uneventful and the patient was discharged after 2 days. The 4-month follow-up showed a satisfying functional and aesthetic outcome with a concealed donor site scar. This report points out the coverage potential of the thin SMAP flap, which can be successfully used for a harmonious reconstruction in both color and texture of the upper lip.

Flap Selection Approach for Hand Soft Tissue Defects Reconstruction: Surgical Techniques and Outcome Evaluation

Background: The hand is an intricate part of the body that plays an essential role in social functioning, expression, productivity, and interactions with our environment.Many flap options have been described to address the specific functional and anatomic requirements in soft tissue reconstruction of the hand. The aim of this study isto find the ideal donor tissue for coverage of soft tissue defects of the hand to achieve wound closure and maintain joint and hand function. Patients and methods: A prospective study wasconducted betweenfrom April 2018 and May 2019, on all patients with soft tissue defects of the hand presented to plastic surgery department, Qena faculty of medicine,South Valley University. Results:There were 62 hand injuries in 50 patients with a mean age of 35 years (range, 1- 69 years). The etiologies of the injuries were mostly due to post-traumatic raw areas (86%). In our study we divided cases into 4 main groups, the first group including fingertip injuries, second group proximal to fingertips, third group palm and fourth group dorsum of the hand. The distribution of the hand injuries were 48 fingertips injury, 8 injuries proximal to fingertips, palm injury in one patient and injuries over hand dorsum in 5 patients.The follow up period was ranged 1 to 6 months. Conclusion:An algorithmic approach for coverage of the hand soft tissue defect seems to provide predictable results regarding flaps survival and preservation of finger length.

Free Lateral Thigh Flap for Coverage of Complex Extremity Defects: A Retrospective Case Series at a Tertiary Care Hospital in an LMIC

The lateral thigh flap is a versatile flap that provides many advantages over other free flaps. It has become a mainstay in soft tissue reconstruction of defects in the head and neck, upper and lower extremities.

Use of Homodigital Reverse Island Flaps for Digital Reconstruction-The Perspective of a Reconstructive Surgery Unit in Accra, Ghana

Several Local flaps can be used for the reconstruction of digital soft tissue defects with exposure of tendons and/or phalanges. The homodigital flap is a versatile option. This article discusses the use of the homodigital reverse vascular island flap-a regional, axial-patterned skin flap in the reconstruction of distal digital defects. Methods: 6 patients with a soft-tissue defect at the distal part of the finger were treated by homodigital island flaps for reconstruction. We evaluated the active range of motion of the involved finger, and the patient's satisfaction with the appearance of the finger after reconstruction. Results: All patients admitted to a good functional outcome. The donor site morbidity was minimal. The take of the split-thickness skin graft to the flap donor site was generally good. However one patient complained of numbness of the finger over the donor site Conclusion: The Homodigital flap is a handy multipurpose flap that can be used. Notwithstanding its limitation, it is easy to raise and it can be used to a variety of defects

An algorithm for the reconstruction of nonfingertip upper extremity soft tissue defects

Aims: The aim of this study was to evaluate the advantages and disadvantages of reconstructive methods used in the upper extremity soft tissue defects other than the fingertips, according to location. Materials and Methods: This retrospective study included 212 patients operated between January 2012 and January 2019 due to upper extremity soft tissue defects excluding the fingertip. Patients were evaluated in terms of age, gender, etiology, reconstruction area, method, and complications. Statistical Analysis Used: The relationship between the reconstructive method or location and the complication was evaluated by one-way analysis of variance test. The relationship between categorical variables was tested by Kruskal–Wallis test. The significance of multiple comparisons was adjusted using Bonferroni correction. Results: The average age of patients was 35.4 ± 19.12 years; 168 were male and 44 were female. 158 patients were operated for trauma, 34 for malignant tumor, 12 for infection, and 8 for extravasation. Complications were observed in 19 of the 220 reconstructive procedures (8.6%): two of the local flaps, three distant flaps, two regional flaps, five perforator flaps, and seven free flaps. 26% of these complications were seen in fingers, 15% in hands, 42% in wrists, 5.2% in forearms, 5.2% in elbows, and 5.5% in arms. Conclusions: There are many procedures for upper extremity reconstruction that can be selected according to defect location and character. It should be kept in mind that complex reconstructions that are preferred especially in complicated injuries may end up with challenging complications. In these types of complicated injuries, it would be better to prefer a reconstructive ladder instead of a reconstructive elevator.

Reconstruction of Hand and Wrist Soft-Tissue Defects using Radial Artery Perforator Flap

Aim: Soft-tissue defects in the hand and wrist are frequently encountered injuries that may occur due to trauma, burns, or other causes. We aimed to report our experiences in reconstruction of these defects using a radial artery perforator flap (RAPF). Materials and Methods: Eight patients who underwent surgery for reconstruction of the hand and wrist soft-tissue defects at our institution between December 2017 and December 2019 were included in the study. The patients were evaluated in terms of age, sex, etiology, flap size, defect region, and postoperative complications. Results: All defects were reconstructed by utilizing RAPF. The most common etiology of the defects was work-related accidents. The mean age of the patients was 40.4 (10–69) years. The mean flap size was 63.5 ± 14.76 cm2. Six patients healed uneventfully, while we observed partial necrosis of the RAPF flap in one of the cases and a marginal epidermolysis in another. The donor sites were skin grafted in each patient. The patient where partial necrosis observed was re-operated for debridement and skin grafting subsequentially. The duration of follow-up of the patients was 6 months. Conclusions: Radial forearm perforator flap is a reliable and effective reconstructive option to reconstruct small to moderately sized defects of the hand and wrist.