Temporal Fascia Free Flap for Thumb Coverage in Electrical Burn Injuries: A Case Series Analysis With DASH Score Outcomes Evaluation

Electrical burns pose unique challenges in reconstructive surgery due to the extensive tissue damage they cause. The thumb is particularly susceptible to electrical burns, leading to severe functional impairment. This case series introduces the use of the temporal fascia free flap for thumb coverage in patients with electrical burn injuries. The study aims to assess the functional outcomes of this approach using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Six male patients underwent thumb reconstruction using temporal fascia free flaps following electrical burn injuries. The extent of the injury was assessed, and necrotic tissue was debrided. Functional outcomes were evaluated using the DASH questionnaire 6 months postoperation. All procedures were conducted in accordance with ethical guidelines, and informed consent was obtained from all patients. All patients achieved successful transplants using temporal fascia free flaps. The average DASH score at the 6-month follow-up indicated satisfactory functional recovery. Patients reported improvements in thumb mobility and functionality, and the cosmetic appearance of the thumb was acceptable. The appearance of the scar in the donor area was well-received. The temporal fascia free flap proved to be an effective method for thumb reconstruction following electrical burn injuries. Its thin and flexible nature allows for optimal contouring and improved range of motion. Although one case of partial flap loss was observed, overall functional and aesthetic outcomes were satisfactory. Further research with larger sample sizes is warranted to optimize surgical techniques and postoperative care for better outcomes.

Distal Brachial Artery Perforator flap: a new chimeric option for complex hand and digits defects

INTRODUCTION

Reconstruction of fingers pose unique challenges, as a thin and flexible flap is needed in order to guarantee a good functional outcome. For the first time, in this report, we present the DBAp (distal brachial artery perforator) flap, based on the distal perforator closer to the medial epicondyle. The DBAp flap was used to reconstruct complex digit defects as free flap, and to cover an elbow defect while raised as a propeller.

METHODS

Four patients underwent finger reconstruction (free flaps): two patients presented an unstable finger scar following previous surgery, whereas the other two patients presented a terminalized finger at the level of the middle phalanx. A further patient presented a post-traumatic loss of substance at the elbow and was reconstructed using a perforator propeller DBAP flap.

RESULTS

Loss of tissues included skin and subcutaneous tissue in all patients and in one patient it included a bone component. Flap dimensions ranged from 48 to 18 cm² (average: 32 cm²). Among complications, patient n.2 flap presented a marginal flap necrosis requiring a small skin graft after necrosis debridement.

CONCLUSION

The DBAp flap provides a slim, glabrous and pliable skin tissue with a well-hidden donor site scar and thanks to the anatomic location of the distal perforator can be designed to include a vascularized bone graft from the medial epicondyle. Despite the low number of cases, we believe that this flap should be considered as a dependable and effective source for complex reconstructions of both soft tissue and bone in fingers.

Integra: An Alternative Option for Reconstruction of Extensive Finger Defects With Exposed Bones

Extensive soft tissue injuries with exposed joints, bones, and tendons due to trauma of the hand -particularly fingers- necessitate soft tissue reconstruction and coverage. However, these injuries are challenging; therefore, various management options for traumatic skin loss over fingers are widely performed. These options comprise wound care permitting wound contracture without surgical intervention, full or split-thickness skin grafting, skeletal shortening and primary closure, and various types of flaps. We present a case of successfully placed Integra over the exposed phalangeal bones followed by split-thickness skin grafting a few weeks later, with a good outcome. We conclude that Integra is an alternative, safe and effective method for reconstructing severely traumatized fingers with exposed bone, tendon, or joint without sacrificing outcome.

Modified Heterodigital Neurovascular Island Flap for Sensory Reconstruction of Pulp or Volar Soft Tissue Defect of Digits

PURPOSE

We report the efficacy of a modified heterodigital neurovascular island flap innervated by the dorsal branch of the proper digital nerve and the proper digital nerve, for repairing either pulp or volar defects in the fingers.

METHOD

We repaired 14 digits of 14 patients who had a complex defect involving soft tissue and digital nerve in the pulp or volar surface of the digit using the modified heterodigital neurovascular island flap. Cases were divided into 2 groups: a pulp defect group including 5 thumbs and 1 little finger; and a volar defect group with a digital nerve defect, involving one thumb, 3 index and 3 middle fingers, and one ring finger. At the recipient site, nerve stumps of the PDNs in the pulp defect group were coapted with the proximal ends of the dorsal branch of the PDN and the proper digital nerve in the flap. The distal and proximal ends of the PDN in the flap were intercalated into the defect of the PDN in volar defect group, and the proximal end of dorsal branch of PDN in the flap was also coapted to the proximal end of the proper digital nerve of the recipient finger. At the donor site, the defect of the proper digital nerve was repaired with nerve graft harvested from the proximal portion of the dorsal branch of the same proper digital nerve, and a full-thickness skin graft covered the donor site.

RESULTS

All flaps and the skin grafts of the donor site survived completely. At the final follow-up, 9 of 14 flaps had a static 2-point discrimination result below the normal threshold (< 6 mm).

CONCLUSIONS

The modified heterodigital neurovascular island flap is a useful and reliable treatment option for a digital pulp or volar defect, especially when the digital nerve defect requires repair.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Functional Reconstruction of Severely Burned Hand With Osseous Blood Flow Deficiency With Immediate Surgery Using an Abdominal Bipediceled Flap: A Case Report

Objective: When hands suffer burns, the tendons and digital bones are rarely injured because of the quick withdrawal reflex away from the heat source. Hence, a consensus of opinion regarding the treatment of severe hand burns with osseous blood flow deficiency has not been reached among clinicians. Methods: The patient was a 28-year-old woman whose fingers were accidentally soaked in heated cooking oil (160°C-170°C) for approximately 1 minute. The result was fourth-degree (extending to the tendon) digital burns of the distal end of the proximal interphalangeal joint with blood flow deficiency to the skin, tendon, and bone. Results: We performed immediate reconstructive surgery using an abdominal bipediceled flap. Two weeks later, after the flap was separated, all fingers showed complete range of motion, restoration of the metacarpophalangeal joint, and a high range (0°-75°) of proximal interphalangeal joint mobility with an acceptable digital length. Conclusions: Our experience shows that immediate surgery is highly preferable for deep burns of the hand to avoid delayed intractable complications and to achieve better and faster results.

Free serratus anterior fascial flap combined with vascularized scapular bone for reconstruction of dorsal hand and finger defects

We present two cases of serratus anterior free fascial flap combined with vascularized scapular bone graft for reconstruction of traumatized dorsal hand and phalangeal bone defects. Composite flaps with single vascular pedicles allowed conservation of severely injured fingers and provided good functional and cosmetic outcomes.