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Ryoo HJ, Park SH, Park JA, Kim YH, Shim HS. Multiple digit resurfacing with a lateral thoracic free flap: Two-stage mitten hand and division procedures. Microsurgery 2023; 43:570-579. [PMID: 37415509 DOI: 10.1002/micr.31090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/23/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE The conventional abdominal and groin flaps for resurfacing the defect have several disadvantages, including the risk of flap failure due to accidental traction or detachment, immobilization of the arm before division, and aesthetic dissatisfaction because of the flap bulkiness. The aim of this study was to share our experiences with the free lateral thoracic flap and elucidate the optimal timing of division in complex hand reconstruction, which yielded favorable outcomes in terms of both functionality and aesthetics. METHODS This article is a retrospective review of multiple digit resurfacing using free tissue transfer from 2012 to 2022. Patients who underwent two-stage operation including mitten hand creation using superthin thoracodorsal artery perforator (TDAp) free flap and secondary division were included. A flap was elevated over the superficial fascia layer the midportion between the anterior border of the latissimus dorsi and pectoralis major muscles and once the pedicle was found, an outline that matched the defect was created. A process named "pushing with pressure and cutting" was carried out before pedicle ligation until all the superficial fat tissue had been removed except for around the perforator. Two cases (18%) involved defects of the entire fingers reconstructed by TDAp flap with anterolateral thigh flap. Six cases (55%) had a super-thin TDAp flap only. In two cases (18%), non-vascularized iliac bone grafting was required for finger lengthening. One case (9%) was resurfaced with a TDAp chimeric flap including a skin paddle with the serratus anterior muscle. The primary outcome was defined as the survival or failure of the flap, while the secondary outcomes associated complications such as infection and partial flap necrosis. A statistical analysis was not performed due to the size of the case series. RESULTS All 13 flaps survived completely without any complications. Flap dimension ranged from 12 cm × 7 cm to 30 cm × 15 cm. Mitten hand duration prior to division was 41.9 days on average which was essential for the optimal result. During the division procedures, there were nine cases of debulking (82%), six cases of split-thickness skin graft (STSG) (55%), and three cases of Z-plasty performed on the first web space (27%). The mean follow-up period was 20.2 months. Mean Disability of the Arm, Shoulder, and Hand (DASH) Questionnaire score was 10.76. CONCLUSIONS We resurfaced severe soft tissue defects of multiple fingers with thin to super-thin free flaps, mainly TDAp flaps. Surgeons can restore original hand shape using a two-stage reconstructive strategy of mitten hand creation and proper division timing to create a 3-dimensional hand structure, even in severely injured hands with multiple soft tissue defects of the digits.
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Affiliation(s)
- Hyun Jung Ryoo
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sang Hyun Park
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Ji Ah Park
- Design Lab of Technology Commercialization Center, Industry-University Cooperation Foundation of Hanyang University, Seoul, South Korea
| | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Hyung-Sup Shim
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Whitehouse H. Comparison of Thigh-Based versus Groin-Based versus Lateral-Thoracic-Based Flaps for Hand Resurfacing: A Review Article. World J Plast Surg 2021; 10:3-8. [PMID: 34912661 PMCID: PMC8662678 DOI: 10.29252/wjps.10.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 05/03/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Thigh-based, groin-based and lateral-thoracic-based flaps are available for microsurgical hand resurfacing – which is the best? METHODS BestBETS methodology was used to systematically evaluate the advantages and disadvantages. PubMed, EMBASE and Cochrane databases were searched up until Sep 2020, using the search strategy: hand re-surfacing, free-flap, groin-flap, thigh-flap, lateral thoracic-flap, advantages, and disadvantages. RESULTS Overall, 31 papers were identified which were used to synthesize the discussion and conclusions. CONCLUSION Thigh-based anterolateral thigh (ALT) flaps offer the greatest versatility.
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Affiliation(s)
- Harry Whitehouse
- Queen Mary University London, Mile End Rd, Bethnal Green, London E1 4NS
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3
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Ren J, Lu L, Gao F. The use of the posterior interosseous artery flap and anterolateral thigh flap for post-traumatic soft tissue reconstruction of the hand. Medicine (Baltimore) 2021; 100:e26517. [PMID: 34190184 PMCID: PMC8257892 DOI: 10.1097/md.0000000000026517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/11/2021] [Indexed: 01/04/2023] Open
Abstract
The purpose of this study was to examine the differences between the use of a posterior interosseous artery (PIA) flap and an anterolateral thigh (ALT) flap for post-traumatic, medium-sized soft tissue reconstruction of the hand based on flap characteristics, postoperative complications, and aesthetic outcomes.From October, 2010 to March, 2016, 62 patients undergoing soft tissue reconstruction of the hand with 30 PIA flaps and 32 ALT flaps were included in this study. The 62 patients were divided into the PIA flap group and the ALT flap group. The differences between the 2 groups were analyzed.The 62 patients included 52 males and 10 females, and the mean age at the time of surgery was 41 years. The flap failure rate was 13.3% (4/30) in the PIA flap group and 9.4% (3/32) in the ALT flap group. No significant differences in flap failure rate, recipient site complication rate, or donor site complication rate were observed between the 2 groups. However, the operative time (136 min vs 229 min) and aesthetic outcomes (flap bulk swelling, 0 cases vs 31 cases) were statistically significantly different.Both the pedicled PIA flap and the free ALT flap were comparable for the reconstruction of post-traumatic, medium-sized soft tissue defects of the hand according to the evaluated outcomes of postoperative complications. Based on the surgical characteristics of the flap and the evaluation of aesthetic outcomes, the pedicled PIA flap was significantly superior to the free ALT flap.
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Affiliation(s)
- Jinyan Ren
- Department of Health Management Center, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, Shandong, China
| | - Laijin Lu
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, No. 76 Xinmin Street, Changchun, Jilin, China
| | - Fei Gao
- Department of Hand and Foot Surgery, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, Shandong, China
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4
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Comparison of Thigh-Based versus Groin-Based versus Lateral-Thoracic-Based Flaps for Hand Resurfacing: A Review Article. World J Plast Surg 2021. [DOI: 10.52547/wjps.10.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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5
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Ortiz R, Ozkan S, Chen NC, Eberlin KR. Firework Injuries of the Hand: An Analysis of Treatment and Health Care Utilization. Hand (N Y) 2020; 15:831-836. [PMID: 30880517 PMCID: PMC7850250 DOI: 10.1177/1558944719829905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Firework injuries to the hand can be devastating due to the explosive and ballistic nature of these devices. The aim of this study was to describe the injury and treatment characteristics of patients requiring surgery for firework-related hand injuries and to investigate which factors are associated with an increased utilization of health care resources. Methods: A retrospective chart review of patients undergoing surgery for firework-related hand injuries at two American College of Surgeons level I trauma centers between 2005 and 2016 was performed. Twenty cases were identified. These patients were evaluated for demographics, injury characteristics, number and types of surgical interventions, length of stay, and utilization of health care resources. Bivariate analyses were performed to investigate which factors were associated with increased consumption of health care resources. Results: Injuries ranged from digital nerve injuries to traumatic amputation. Patients underwent a median of 3 surgical operations. More than half the patients underwent flap or skin graft coverage of a soft tissue defect. The median length of hospital stay was 7 days. Factors found to be associated with an increased utilization of surgical and hospital resources included a first web space injury, thumb fracture, and traumatic amputation of any digit. Conclusions: The morbidity inflicted by firework injuries to individual patients is substantial. Patients with severe injuries undergo a median of three surgical operations and have a long duration of initial hospital stay. Knowing which factors are associated with an increased utilization of resources can help prognosticate these preventable injuries.
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Affiliation(s)
- Ricardo Ortiz
- Massachusetts General Hospital, Division of Plastic and Reconstructive Surgery, Harvard Medical School, Boston, USA
| | - Sezai Ozkan
- Massachusetts General Hospital, Department of Orthopedic Surgery, Harvard Medical School, Boston, USA
| | - Neal C. Chen
- Massachusetts General Hospital, Department of Orthopedic Surgery, Harvard Medical School, Boston, USA
| | - Kyle R. Eberlin
- Massachusetts General Hospital, Division of Plastic and Reconstructive Surgery, Harvard Medical School, Boston, USA
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6
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Abstract
Microsurgical tissue transfer may provide reconstructive option for extensive loss of tissues due to upper extremity trauma or tumor resection. This article reviews the authors' experience in using microsurgical tissue transfers for reconstruction of upper extremity trauma.
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Affiliation(s)
- Chao Chen
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan 250021, Shandong, China
| | - Zeng Tao Wang
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan 250021, Shandong, China; Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
| | - Li Wen Hao
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan 250021, Shandong, China
| | - Lin Feng Liu
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan 250021, Shandong, China
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Development of an integrative algorithm for the treatment of various stages of full-thickness burns of the first commissure of the hand. Burns 2017; 43:812-818. [DOI: 10.1016/j.burns.2017.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/14/2016] [Accepted: 01/06/2017] [Indexed: 11/24/2022]
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8
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Giesen T, Adani R, Carmes S, Dumontier C, Elliot D, Calcagni M. IFSSH scientific committee on skin coverage: 2015 report. HAND SURGERY & REHABILITATION 2016; 35:307-319. [PMID: 27781975 DOI: 10.1016/j.hansur.2016.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 05/15/2016] [Accepted: 07/26/2016] [Indexed: 11/20/2022]
Abstract
Skin coverage in hand reconstruction is a challenging and vast chapter in hand surgery; covering every aspect of it in a report is simply not feasible. Therefore, this report focuses on a few specific topics. The coverage of anatomical regions like the fingertips is common ground for hand surgeons worldwide, but in the last 10 years, various refinements have been published in order to optimize the reconstruction of this organ. Nevertheless, in many emergency departments, the amputation of badly injured fingertips, including the thumb, remains the preferred treatment. The main focus of this report is to counter this tendency by providing alternatives to surgeons. Large defects in the fingers involving more than one segment, defects in the palm and in the dorsum of the hand are currently debated in international meetings. The use of skin substitutes vs. the use of extremely refined microsurgical procedures vs. classic island flaps has generated animated discussions, which are also influenced by cultural and socioeconomic factors around the world. This report offers the views of six surgeons from four different countries, in the hope of animating discussions and suggesting new approaches.
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Affiliation(s)
- T Giesen
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
| | - R Adani
- Department of Hand Surgery, University Hospital of Modena, Modena, Italy
| | - S Carmes
- Department of Plastic Surgery and Hand Surgery, Nice University Hospital, Nice, France
| | - C Dumontier
- Department of Plastic Surgery and Hand Surgery, Nice University Hospital, Nice, France
| | - D Elliot
- Hand Surgery Department, St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, Essex, UK
| | - M Calcagni
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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Del Piñal F, Klausmeyer M, Moraleda E, de Piero GH, Rúas JS, Klich M. Foot web free flaps for single-stage reconstruction of hand webs. J Hand Surg Am 2015; 40:1152-60. [PMID: 25804365 DOI: 10.1016/j.jhsa.2015.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 02/02/2015] [Accepted: 02/03/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To present a method for reconstructing the digital web in posttraumatic defects using a free tissue transfer of the web from the foot and to present the functional and aesthetic results. METHODS Nine web free flaps were performed; 8 were used to reconstruct posttraumatic web losses and 1 was used to reconstruct a defect resulting from to infection. All cases involved the first (3) or second (6) webs of the hand. Web flaps were taken from the foot first web (2 patients), from the second (6 cases), and from the third (1 case) in a patient with congenital syndactyly of second foot web space. The donor site was managed by skin grafting from the instep (1 case), creation of a syndactyly (7 cases), or both (1 case). RESULTS All flaps survived without complications. Finger abduction and flexion-extension were similar to the contralateral side. No functional limitations, pain, or contracture were reported. One donor site healed with hypertrophic scars; otherwise, no donor site complications occurred. On a visual analog scale (0-10), the patient assessed appearance of the hand and the donor foot as 9.0 and 9.0, respectively, on average. One web was not well-positioned in the first operation and required revision. CONCLUSIONS The foot web free flap reconstructs the hand web by replacing it with a similar functional subunit rather than attempting to recreate the complex geometry, and allows for full function and excellent appearance of the hand. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Francisco Del Piñal
- Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain.
| | - Melissa Klausmeyer
- Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain
| | - Eduardo Moraleda
- Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain
| | - Guillermo H de Piero
- Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain
| | - Jaime S Rúas
- Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain
| | - Maciej Klich
- Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain
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10
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Sirimahachaiyakul P, Orfaniotis G, Gesakis K, Kiranantawat K, Ciudad P, Nicoli F, Maruccia M, Sacak B, Chen HC. Keyhole anterolateral thigh flap: A special way of partition for reconstruction around a protruding structure or cavity/tunnel. Microsurgery 2015; 35:356-63. [PMID: 25597746 DOI: 10.1002/micr.22377] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/15/2014] [Accepted: 12/19/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Pornthep Sirimahachaiyakul
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Division of Plastic Surgery; Department of Surgery; Faculty of Medicine Vajira Hospital; Navamindradhiraj University; Bangkok Thailand
| | - Georgios Orfaniotis
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Kanellos Gesakis
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Kidakorn Kiranantawat
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Department of Plastic and Maxillofacial Surgery; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Fabio Nicoli
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
- Department of Plastic and Reconstructive Surgery; Sapienza University; Rome Italy
| | - Bulent Sacak
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung Taiwan
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11
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Doğan F, Çoruh A. Novel Biogeometric Designs of First Dorsal Metacarpal Artery Flap in Hand Reconstruction. J Burn Care Res 2014; 35:e399-405. [DOI: 10.1097/bcr.0000000000000044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Meky M, Safoury Y. Composite anterolateral thigh perforator flaps in the management of complex hand injuries. J Hand Surg Eur Vol 2013; 38:366-70. [PMID: 22117011 DOI: 10.1177/1753193411427648] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The anterolateral thigh (ALT) fasciocutaneous flap has been well described for hand skin cover, however its use in its composite (multiple tissue) form incorporating bone, muscle and/or fascia has been less well described. We report the usefulness of the composite ALT flap in six complex hand trauma cases, four male and two female (age range 14-46 years). The palm of the hand was affected by injury in three cases, the dorsum in two cases, and the radial side in one case. The first web formed part of the injury in three cases. There was variable involvement of the tendons, nerves and bones. Fascia lata was included in the flap to provide a gliding surface in four cases, part of the vastus lateralis muscle was included to obliterate dead space in two cases and to create a first web in one case, and a bone block from the iliac crest was included to reconstruct the lost metacarpals in one case. All flaps survived with minimal complications. This work shows that the anterolateral thigh composite flap is a reliable option when multiple tissue types are required in hand reconstruction.
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Affiliation(s)
- M Meky
- Al-Azhar University Hospitals, Egypt.
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13
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Reconstruction of severe contracture of the first web space using the reverse posterior interosseous artery flap. THE JOURNAL OF TRAUMA 2011; 71:1745-9. [PMID: 22182883 DOI: 10.1097/ta.0b013e3182325e27] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To evaluate the outcome and highlight the operative tips of using the reverse posterior interosseous artery (PIA) flap in the treatment of severe contractures of the first web space. METHODS From 1985 to 2008, the reverse PIA flaps, which included fasciocutaneous flaps in 25 patients and composite flaps in 2 patients were used to cover skin defects over the first web space after release of severe contractures of the first web space. The severe contracture of the first web space was defined as the distance of less than 2 cm between the interphalangeal joint of the thumb and the metacarpophalangeal joint of the index. The flap dimensions varied between 6 cm and 22 cm (average, 13 cm) in length and 3 cm to 9 cm (average, 6 cm) in width. The largest flap was 22 cm × 6 cm and the smallest 6 cm × 3 cm. The length of the pedicle ranged from 2 cm to 10 cm (average, 8 cm). Skin defects of the donor site were covered by split-thickness skin grafts in 26 patients and direct closure in 1 patient. RESULTS Twenty-six of 27 PIA flaps survived completely except venous congestion occurred in 1 patient, which led to necrosis of the distal 1/4 flap. Skin grafts over the donor sites survived completely without complications. The follow-up period ranged from 1 month to 2 years. Lipectomy or revision was performed in two patients because of scar contractures or bulkiness. The postoperative distance of the reconstructed web space was 6 cm on average. CONCLUSION The reverse PIA flap is suited for defect cover in the treatment of severe contractures of the first web space. A usual pitfall using the reverse PIA flap is that the skin paddle is inadvertently outlined over the proximal 1 of 3 forearm to increase its distal reach, which usually leads to postoperative venous congestion. However, if the distal flap pole is placed at or distal to the midpoint from the lateral epicondyle to the radial side of the ulnar head, choosing the proximal 1 of 2 forearm as the donor site of the skin paddle to increase its distal reach is reliable.
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J Krochmal D, M Rebecca A, J Casey W, A Smith A. Anterolateral Thigh Flap Salvage Following Failed Deep Inferior Epigastric Artery Perforator Breast Reconstruction. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2011. [DOI: 10.1177/229255031101900102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The deep inferior epigastric artery perforator flap is an option for women desiring autologous tissue breast reconstruction. If this reconstruction fails, other autologous tissue flaps, including the gluteal artery perforator and latis-simus dorsi flaps, may be used for salvage. The anterolateral thigh (ALT) flap offers adequate tissue volume for breast reconstruction, acceptable fat quality and a long vascular pedicle. Other advantages include obviating the need for intraoperative position changes and harvesting tissue outside of the radiation field. Two cases involving ALT flaps used in the setting of deep inferior epigastric artery perforator failure are presented with favourable results. A review of the anatomy of the ALT flap is included.
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Affiliation(s)
| | - Alanna M Rebecca
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - William J Casey
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Anthony A Smith
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Abstract
BACKGROUND The success of a first web space contracture release is dependent on the individual parameters of thumb movement. Examining these parameters individually, it is possible to predict which components are important for providing successful outcomes. METHODS We identified all patients who underwent a first web space contracture release over 7 years. Patients were examined for the following: radial abduction-abduction of the thumb in the plane of the hand; palmar abduction-abduction of the thumb 90° to the plane of the hand; and opposition-distance between first and fifth palmar digital crease. Measurements were compared between affected and unaffected hands, and correlations between components and patients' Disability of the Arm, Shoulder, and Hand (DASH) scores were determined. RESULTS Thirty-nine patients underwent release of a first web space contracture; 11 agreed to participate. Opposition distance was significantly greater in the affected hand than in the unaffected hand. Grip strength was significantly lower in the affected hand. There were no significant differences in the radial or palmer abduction angles between hands. There was a moderate relationship between opposition distance and DASH score. There was no relationship between DASH and the other physical measurements. CONCLUSIONS It is possible to obtain normal radial and palmar abduction angles after first web space release; however, success is not dependent on these absolute angles of abduction. Success of a release is related to the amount of opposition obtained, and it is difficult to achieve equivalent opposition to the unaffected hand. Grip strength and opposition remain decreased following contracture release.
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Affiliation(s)
- Derek L. Masden
- The Curtis National Hand Center, Union Memorial Hospital, 3333 North Calvert Street, #200 Johnston Professional Building, Baltimore, MD 21218 USA
| | - James P. Higgins
- The Curtis National Hand Center, Union Memorial Hospital, 3333 North Calvert Street, #200 Johnston Professional Building, Baltimore, MD 21218 USA
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16
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Benhaim T, Perignon D, Qassemyar Q, David E, Robbe M, Mertl P, Sinna R. [Reconstruction of hand dorsum soft tissue defect using anterolateral thigh perforator flap: description, case study and review of literature]. CHIRURGIE DE LA MAIN 2011; 30:56-61. [PMID: 21334951 DOI: 10.1016/j.main.2011.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 12/28/2010] [Accepted: 01/10/2011] [Indexed: 10/18/2022]
Abstract
Reconstruction of hand dorsum soft tissue defect usually requires a flap. The dorsal skin is thin and the underlying structures require coverage by vascularised tissue. We have been using perforator flaps in these cases, especially the anterolateral thigh perforator flap. After a description of the technique, we present a case report in which this flap, in a free version, was used to reconstruct a dorsal hand defect after failure of a posterior interosseous flap. The fascia underlying the flap was used to create a sliding interface for extensor tendons. Postoperative care was without complications. The indications of this flap are numerous but after a review of international literature, we found that its use was seldom reported in France compared to other countries. However, we think that its trophic qualities and minor donor site morbidity make it ideal for coverage of hand dorsum soft tissue defects.
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Affiliation(s)
- T Benhaim
- Service de chirurgie plastique, reconstructrice et esthétique, CHU d'Amiens Nord, place Victor-Pauchet, Amiens, France.
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Oh S, Koh S, Chung C. Twin digital and in-step neurovascularised free flaps for reconstruction of the degloved mutilated hands. J Plast Reconstr Aesthet Surg 2010; 63:1853-9. [DOI: 10.1016/j.bjps.2009.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 10/09/2009] [Accepted: 11/03/2009] [Indexed: 11/30/2022]
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18
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First web space post-burn contracture types: contracture elimination methods. Burns 2010; 37:338-47. [PMID: 20851529 DOI: 10.1016/j.burns.2009.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 09/24/2009] [Accepted: 11/02/2009] [Indexed: 11/20/2022]
Abstract
First web space adduction contractures are a common consequence of hand burns. Many reconstructive techniques are used and investigation for more effective methods continues. Effective hand reconstruction usually considers anatomy as its foundation. Based on the experience of over 500 web space contracture elimination cases, three anatomical types of thumb adduction contractures were identified: edge, medial and total. Edge contractures (80% of all thumb adduction contractures) are caused by a fold in which only one sheet is scarred, either the palmar or dorsal surface. The contraction is caused by a trapeze-shaped length deficiency of the scar sheet, which has a surface surplus in width. Reconstruction consists of surface deficiency compensation with trapezoid flap prepared from the non-scarred side and skin-fat tissues of the web space. In most cases, the small scar-fat trapezoid flaps should be prepared from the non-scarred side to cover the donor wounds on both sides of the main flap. Medial contractures (10% of thumb adduction contractures) are caused by the fold, both sheets of which are scarred and have trapeze-shaped surface deficiency in length and surplus in width. Both fold sheets are converted into one or several pairs of trapezoid scar-fat flaps by radial incisions. The oppositely located flaps are transposed towards each other. As a result of the counter flaps transposition, the contracture is eliminated; the web space's shape and depth are restored by the use of flaps alone or in combination with skin grafting. The trapeze-flap plasty is very simple and effective with the length gain of up to 100-200%. Neither flap loss nor re-contracture occurs. Total contractures (about 10% of all) have no fold. Reconstruction consists of the creation of the central zone of the first web space depth with the rectangular subdermal pedicle flap; the wounds on both sides of the flap are skin grafted. The flap sustains normal web depth and prevents the contracture recurrence and skin graft shrinkage.
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Abstract
Blast injuries to the hand are not just a wartime phenomenon but also quite common in rural communities throughout northern California. The purpose of this study is to review our experience with blast injuries in the community and review the most common patterns in an attempt to identify the pathomechanics of the hand injury and the reconstructive procedures that are required. This is a retrospective study of blast injuries to the hand treated between 1978 and 2006. Medical records, X-rays, and photos were reviewed to compile standard patient demographics and characterize the injury pattern. Explosives were classified based on their rate of decomposition. Reconstructive solutions were reviewed and characterized based on whether damaged tissues were repaired or replaced. Sixty-two patients were identified with blast injuries to their hand. Patients were predominantly male (92%) with an average age of 27 years. Firecrackers were the most commonly encountered explosives. Thirty-seven patients were identified as holding a low explosive in their dominant hand and were used for characterization of the injury pattern. The apparent pattern of injury was hyperextension and hyperabduction of the hand and digits. Common injuries were metacarpophalangeal and interphalangeal joint hyperextension with associated soft tissue avulsion, hyperabduction at the web spaces with associated palmar soft tissue tears, and finger disarticulation amputations worse at radial digits. Given the mechanisms of injury with tissue loss, surgical intervention generally involved tissue replacement rather than tissue repair. Blast injuries to the hand represent a broad spectrum of injuries that are associated with the magnitude of explosion and probably, the proximity to the hand. We were able to identify a repetitive pattern of injury and demonstrate the predominant use for delayed tissue replacement rather than microsurgical repair at the acute setting.
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Affiliation(s)
- Ron Hazani
- Division of Plastic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, ACB Building, 2nd Floor, Louisville, KY 40292, USA.
| | - Rudolf F. Buntic
- Division of Microsurgical Transplantation and Replantation, The Buncke Clinic, 45 Castro St. #121, San Francisco, CA 94114 USA
| | - Darrell Brooks
- Division of Microsurgical Transplantation and Replantation, The Buncke Clinic, 45 Castro St. #121, San Francisco, CA 94114 USA
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Loreti A, Di Lella G, Vetrano S, Tedaldi M, Dell'Osso A, Poladas G. Thinned Anterolateral Thigh Cutaneous Flap and Radial Fasciocutaneous Forearm Flap for Reconstruction of Oral Defects: Comparison of Donor Site Morbidity. J Oral Maxillofac Surg 2008; 66:1093-8. [DOI: 10.1016/j.joms.2007.09.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 09/04/2007] [Indexed: 11/16/2022]
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