Soft Tissue Defects Of Hand Research Articles

The application of the improved interosseous dorsal antidromic artery flap in the emergency treatment of hand trauma

Objective To introduce the clinical application of the improved interosseous dorsal antidromic artery issular flap in the emergency treatment of the soft tissue defects in hand trauma. Methods 16 patients were received the interosseous dorsal antidromic artery flap for soft tissue defects in the hand with emergency treatment. Results All 14 flaps survived, tip necrosis occurred in 2 cases which healed without complications. Conclusion It was simple technical and shorten time in hospital with improvement of the emergency operative procedure of interosseous dorsal antidromic artery flap, and could reduce the impact of frequency of anatomic variations and vascular complications. Key words: Surgical flaps; Interosseous dorsal antidromic artery; Cutaneous artery; Emergency

Repair soft tissue defects of multiple-fingers/toes with multiplefoliated flap pedicled by descending branch of lateral circumflex femoral artery.

Ohjeetive To investigate the methods and effects of multiplefoliated flap pedicled by descending branch lateral circumflex femoral artery to repair soft tissue defects of multiplefingers/toes. Methods From June 2005 to December 2008, 8 patients with soft tissue defects of multiple-fingers/toes were repaired with multiplefoliated flap pedicled only by descending branch lateral circumflex femoral artery. Five of them are male and three of them are female, with average age of 27.6 years (range, 22-38 years). Anterolateral thigh perforator flaps with lateral femoral cutaneous nerve pedicled by musculocutaneous perforator or spatium iutermusculare perforator of descending branch of lateral circumflex femoral artery, muscle flaps pedicled by branches of vastus lateralis muscle, rectus femoris muscle, vastus intermedius muscle and distal spatium intermusculare perforator of it respectively were designed to repair soft tissue defects of mnltipie-fingers/toes, at the same time muscle flaps were covered by skin graft, so the soft tissue defects were repaired in one time. Results No vascular crisis happened in eight cases and all skin grafts survived. All cases were followed up from 6 months to 3 years (the average was 10.5 months). The contour of repaired area was good except that the skin grafts had little contracture. Two point discrimination (2-PD) was 8-10 mm of every flap and protective feeling was recovered by skin grafts of every muscle flap. There were no pain and malaise repaired left toe, the second and third toes, weight-bearing and walking were normal. In seven cases of hand soft tissue defects, 1 case was excellent, 4 cases were well and 2 cases were good according to upper extremity function evaluation criteria of Chinese Medical Society for the Surgery of the Hand, the rate of good was 71 percent. Conclusion Soft tissue defects of multiple-fingers/toes can be repaired by multiplefoliated flap only pedicled by descending branch of lateral circumflex femoral artery. Its advantages are only one pair of vessels was anastomosesd and there are no second and plastic operation. It is a good method to repair soft tissue defects of multiple-fingers/toes. Key words: Surgical flaps; Soft tissue injuries; Fingers; Toes

Clinical application of free super-thin anterolateral femoral perforator flap

Objective To explore clinical effect of repairing soft tissue defect in forearm, hand and foot with free super-thin anterolateral thigh perforator flaps. Methods At first the site of perforator vessels were determined by Doppler, then the flaps were designed and harvested with the site as center; the fascia lata and subcutaneous fat were removed by sandhill-likely only the 4.0 cm × 3.0 cm - 3.0 cm×2.5 cm disc-like fascia lata and dermis layer were reserved. 15 traumatic soft tissue defects including forearm, hand and foot were repaired with the ree super-thin antemlateral thigh perforator flaps. Results No vascular crisis happened and all skin grafts survived in donor sites. 2.0 cm×1.2 cm of the distal of flap was necrosis in 1 case and it was healed by dress changing. 15 cases were followed up 3 months-2 years and the average is 6 months. The contour and texture of all flaps were good and two point discrimination (2-PD) was about 8-10 mm of. Conclusions The contour and texture of free super-thin anterolateral thigh perforator flap are good, the feeling of recipient site recovered well, it's less injury for donor site and there is no reshaping for flap. It is a fineness donor site for repairing soft tissue defects in hand and foot. Key words: Anterolateral femoral flap; Perforator flap; Microsurgery

Anatomy and application of free medial plantar perforator flap

Objective To reports to anatomy and clinical application of the medialis pedis perforator flap. Methods The origin, course, distribution and out diameter of medial plantar perforators, which were located at the septums between the abductor hallucis muscle and the flexor digitorum brevis, and between the abductor hallucis muscle and the skeleton, were observed on 10 sides adult feet specimens perfused with red latex. 11 free medialis pedis perforator flaps were transferred for soft-tissue defect in hand. The areas of tissue defect ranged from 2 cm x 2 cm - 9 cmx 4 cm. Results The medial plantar artery sends 2 perforators with regular anatomy through the septum between the abductor hallucis muscle and the flexor digitomm bre-vis, and 2 perforators with regular anatomy through the septum between the abductor hallucis muscle and nav-icluar bone and the medial cuneiform bone. These perforators supply the medial plantar flap and medialis pedis flap respectively. All of the 11 cases of free medialis pedis perforator flap survived uneventfully. The flap areas ranged from 2 cm × 3 cm - 11 cm× 5 cm. The appearance and functional results were satisfactory with following up for 6 to 24 months. Conclusion The free medialis pedis perforator flap is a good method in repairing soft-tissue defect in hand. Key words: Surgical flaps; Perforator flap; Transplantation; Microsurgery

Clinical study of dorsal ulnar artery flap in hand reconstruction

Soft tissue defects of hand with exposed tendons, joints, nerves and bone represent a challenge to plastic surgeons. Such defects necessitate early flap coverage to protect underlying vital structures, preserve hand functions and to allow for early rehabilitation. Becker and Gilbert described flap based on the dorsal branch of the ulnar artery for defects around the wrist. We evaluated the use of a dorsal ulnar artery island flap in patients with soft tissue defects of hand. Twelve patients of soft tissue defects of hand underwent dorsal ulnar artery island flap between August 2006 and May 2008. In 10 male and 2 female patients this flap was used to reconstruct defects of the palm, dorsum of hand and first web space. Ten flaps survived completely. Marginal necrosis occurred in two flaps. In one patient suturing was required after debridement and in other patient wound healed by secondary intention. The final outcome was satisfactory. Donor areas which were skin grafted, healed with acceptable cosmetic results. The dorsal ulnar artery island flap is convenient, reliable, and easy to manage and is a single-stage technique for reconstructing soft tissue defects of the palm, dorsum of hand and first web space. Donor site morbidity is minimal, either closed primarily or covered with split thickness skin graft.

Clinical study of dorsal ulnar artery flap in hand reconstruction

ABSTRACTSoft tissue defects of hand with exposed tendons, joints, nerves and bone represent a challenge to plastic surgeons. Such defects necessitate early flap coverage to protect underlying vital structures, preserve hand functions and to allow for early rehabilitation. Becker and Gilbert described flap based on the dorsal branch of the ulnar artery for defects around the wrist. We evaluated the use of a dorsal ulnar artery island flap in patients with soft tissue defects of hand. Twelve patients of soft tissue defects of hand underwent dorsal ulnar artery island flap between August 2006 and May 2008. In 10 male and 2 female patients this flap was used to reconstruct defects of the palm, dorsum of hand and first web space. Ten flaps survived completely. Marginal necrosis occurred in two flaps. In one patient suturing was required after debridement and in other patient wound healed by secondary intention. The final outcome was satisfactory. Donor areas which were skin grafted, healed with acceptable cosmetic results. The dorsal ulnar artery island flap is convenient, reliable, and easy to manage and is a single-stage technique for reconstructing soft tissue defects of the palm, dorsum of hand and first web space. Donor site morbidity is minimal, either closed primarily or covered with split thickness skin graft.

Reverse Radial Forearm Fascial Flap with Radial Artery Preservation

The reverse radial forearm fascial (RRFF) flap is widely used in soft-tissue reconstruction of the hand. The traditional RRFF flap incorporates the radial artery from the forearm and is perfused by retrograde flow through the palmar arch. In patients with an abnormal Allen test because of an incomplete palmar arch, the traditional RRFF flap is contraindicated unless a vein graft is used to reconstruct the radial artery. A simpler alternative approach for hand reconstruction in such patients is a distally based RRFF flap based on radial artery perforators, which preserves the radial artery. We used RRFF flaps based on radial artery perforators in five patients who had palmar or dorsal soft-tissue loss. All five recovered full hand function, and only one had any complications (full-thickness skin graft loss at recipient site). The RRFF flap based on distal radial artery perforators is suitable for thin coverage of soft-tissue defects in hands with either a complete or an incomplete palmar arch.

Repair of hand soft tissue defects with vascularized fascia lata flap plus free skin flap

目的 总结吻合血管的阔筋膜瓣加游离皮片移植修复手部软组织缺损的临床应用效果.方法 1998年5月～2005年2月修复18例手部软组织缺损,行一期中厚网状游离植皮,供区直接缝合,阔筋膜瓣的血管蒂与受区的血管行端端吻合.结果 术后1例因静脉危象失败,2例发生远端尖部小片植皮坏死,经换药后逐渐愈合.15例患者术后顺利成活,术后获1～6年(平均3.5年)随访,供区愈合良好,受区质地及厚薄均较好,手部功能恢复满意.结论 阔筋膜瓣以旋股外侧动脉降支为血供,血运丰富、血管解剖恒定、血管蒂长及切取容易,其质地及厚薄均适宜修复手部软组织缺损。

Reconstruction of Hand Soft-Tissue Defects: Alternatives to the Radial Forearm Fasciocutaneous Flap

Soft-tissue defects of the hand and wrist are not an uncommon problem confronting the hand surgeon. Over the past 20 years the retrograde radial forearm fasciocutaneous flap has gained widespread acceptance in reconstruction of these defects. Appreciation of the inherent limitations of this workhorse flap and increased understanding of the blood supply of the upper extremity have prompted the development of several alternative pedicled forearm flaps. Aspects of surgical technique, specific limitations, and indications for the radial forearm fascial flap, the posterior interosseous artery flap, the retrograde radial artery perforator flap, and the dorsal ulnar artery flap are discussed and a reconstructive algorithm for flap selection is presented.

Le lambeau-greffe abdominal : intérêt pour la couverture des pertes de substance tégumentaires dorsales de la main et des doigts chez le brûlé. À propos de six cas

We report six cases of abdominal flap-graft used to cover post-burn soft tissue defects of hands. The technique used was first described by Colson and is applied in our study to an abdominal donor site. Debulking of the flap at the time of elevation resulted in a skin quality as good as a full thickness graft without jeopardizing flap vitality and reliability. Digit mobilization was possible after separation. Long term functional results were found to be satisfactory, specially for the hand. For the fingers it is mostly a digit-rescue surgery. The application of this technique remains sparse. Still, the abdominal flap-graft is often useful in cases of burn patients because of the poor local conditions, as well as the magnitude and nature of injury, which limit the coverage options.

The clinical application of thin flap based on ascending branch of lateral femoral circumflex artery

Objective To report our successful clinical experience of applying thin flaps base d on ascending branch of lateral femoral circumfle x artery.Methods From October 2002,the flaps based on ascending branch of lateral femoral circumflex artery w ere harvested and transplanted afte r removing the deep fascia and most of adipose tissues in repair of 5cases of soft ti ssue defects.Result All the transplanted flaps survived.Conclusion Since the flap can be made thin and obtained from inconspicuous and large donor s ite,it is reliable and excellent in r epairing soft tissue defects of hands and feet.[

Clinical application of ilioinguinal flap

目的 观察髂腹股沟皮瓣修复手部及上肢皮肤软组织缺损的治疗效果.方法对358例手部及上肢软组织缺损伴深部组织外露应用该皮瓣进行修复,面积4cm×4.5cm～15cm×22cm.结果本组358例,26例有不同程度的血运障碍,2例皮瓣部分坏死,余全部成活.随访10个月～5年,外观及功能满意.结论该皮瓣切取方便、血运丰富、质地良好,是修复手部及上肢软组织缺损的好方法。

Transplantation of free scapular flap to repair soft tissue defects in hand and wrist

目的 探讨游离肩胛皮瓣在修复手腕部软组织缺损中的应用价值.方法 1997年1月至2002年6月,用游离肩胛皮瓣修复手腕部软组织缺损25例,其中单纯手背侧缺损14例,手背、腕背均缺损9例,手掌侧缺损2例.按常规切取游离肩胛皮瓣,面积最大23cm×12cm,最小8cm×6cm;以旋肩胛动脉为血管蒂,蒂长4～6cm,平均5.1cm.结果 25例皮瓣全部存活,其中1例术后出现动脉危象,手术探查证实为吻合口栓塞,取栓后重新吻合血管,皮瓣存活.术后随访6个月～3年,皮瓣色泽、质地良好,厚度适宜.结论肩胛皮瓣血供可靠,切取方便,是修复手腕部软组织缺损较理想的皮瓣,可作为修复手背部软组织缺损的首选皮瓣。

Repair and reconstruction of massively damaged burn wounds

Objective: To report repair and reconstruction of massively damaged burn wounds under unusual condition. Methods: One hundred forty-eight patients with deep burn tissue defects admitted from January 1993 through December 2000 were analyzed, among them 96 patients suffered from electrical injury which constituted 65.3% of all cases, 18 patients with hot press injury, 18 cases with deep burns as a result of CO poisoning or epileptic seizure, accounting for 12.2 and 12.2%, respectively, 6 cases with radiation injury, comprising 4.0% of all cases, 2 cases with explosive injury, 2 cases with chemical burn and 6 cases caused by erosive chemicals and wound infection. One hundred seventy-six flaps were transferred with mostly local flaps to repair deep burn wounds in 148 patients with tissue defects, in which necrotic tendons were replaced by acellular allogeneic tendons simultaneously in seven cases. Sixty-one iliolumbar arterial axial skin flaps for coverage of soft-tissue defects in hands or wrists were transplanted. Technical innovations to repair large soft-tissue defects of temporal region and ear, chin and lip, and dorso-lateral aspect of foot due to deep burn were explored. New technics to define necrotic tissue and vascular damage as a result of electrical injury were developed. Results: The biggest dimension of flaps in this group was 22 cm×30 cm. The survival rate of flap was 96.5%, while necrosis of the tip of flap occurred in 3.5%. The function and configuration were satisfactory after 4 months to 8 years follow-up. The technique of 99Tcm-methylene di-phosphonate (99Tcm-MDP) scintigraphy helped identify necrotic tissue before operation, and with the help of digital subtraction arteriogram (DSA) arterial injury could be identified. B-mode ultrasound was helpful to show the extent of endothelial injury, and Colour Doppler was useful to show luminal blood flow signal and filling defect in the injured artery. Conclusions: Repair and reconstruction of massively damaged burn wound at early stage could be achieved. Techniques which helped define the extent of damage to the soft tissues, including arteries and tendons were essential preoperatively for successful reconstruction. Functional and aesthetic reconstruction, as well as the general condition of the patients, could thus be significantly improved early after the devastating injuries. Further innovations of operative technics would benefit more patients with such injuries.

The distally based radial artery/flexor carpi radialis muscle flap for dorsal hand reconstruction: A clinical and cadaver study

Complex soft tissue defects of the hand often require vascularized tissue for protection and coverage of exposed underlying structures. Pedicled local flaps from the forearm are one reconstructive option, but its use is limited by relatively high donor-site problems, including a disagreeable forearm scar and potential division of superficial forearm nerves. We describe a pedicled local flap option--the distally based radial artery/flexor carpi radialis flap, which potentially decreases forearm donor-site morbidity while still providing for coverage of small hand soft tissue defects. Six cadaver forearm dissections were performed to confirm that the vascular supply to the middle and distal portion of the flexor carpi radialis comes off the radial artery. Four clinical cases are presented in which the flexor carpi radialis muscle based on the distal radial artery was used to cover complex wounds of the dorsum of the hand. We believe the lack of damage to the superficial sensory forearm nerves and the ease of flexor carpi radialis muscle flap elevation make this a versatile flap for small, complex, soft tissue defects of the hand.