Repair of two skin and soft tissue defect in hand by three types of multiple flaps from the foot / 中华显微外科杂志

Objective To explore the clinical outcomes of three types of multiple flaps from the foot for re-construction of two skin and soft tissue defects in hands. Methods From February, 2003 to September, 2015, 23 cases of hands with two skin and soft tissue defects were treated with 3 types of multiple flaps from the foot. Among of them, 10 cases of adjacent fingers were treated with double foliated pulp flaps from the big toe and the second toe based on a single vascular pedicle of the first dorsal metatarsal vessels; 2 cases of composite tissue defect including finger and hand were treated with double foliated pulp flaps from dorsalis pedis flap and the big toe based on a single vascular pedicle of the dorsalis pedis artery;11 cases of two composite tissue defect in hand were treated with dorsalis pedis flaps based on a single vascular pedicle of the dorsalis pedis artery. The donor site was covered with full-thick-ness skin. All patients were followed-up regularly which included three aspects:appearance, hand function and senso-ry recovery. Results Twenty-three cases of double foliated pulp flaps were survived. Postoperative follow-up time ranged from 3 to 36 months, with an average of 15 months. The postoperative follow-up revealed satisfactory shapes of the multiple flaps and recovery of functions. The sensation was recovered to S 2-S4. The grafting skin in donor site sur-vived completely excluding partial necrosis in 3 cases. The wound were treated by wound dressing, local scar hyper-plasia in donor sites. There was no apparent impairment on the foot function. Conclusion Three types of multiple flaps from the foot based on a single vascular pedicle for reconstruction of two skin and soft tissue defects in hand could achieve good clinical outcomes. The type of flaps can be adapted according to the injury.

Reconstruction of hand defects / 中华创伤骨科杂志

Hands are an important organ with which mankind has created his civilizations. Functional reconstruction of hand defects is a difficult clinical problem. The cosmetic artificial hand has no other function than that of decoration. The tool hand and kruckenberg forearm furcate phalangisation have scarcely been utilized now because they have limited functions. The myoelectric artificial hand is the major product on the prosthese market, but its accuracy needs improving. Microsurgery can restore part of the sensory functions of the hand but can not restore its normal contour. Treatment of the lost part of the forearm with an electronic artificial hand, which is controlled by a reconstructed digit transplanted from the second toe to the forearm stump, improves the action accuracy. Wide application of this new technique is recommendable. More than 10 cases treated with allograft hand transplantation have been reported recently. Since these patients have to receive a long term therapy of immunosuppressive agents due to the immunological rejection,this method is not suitable to be a routine clinical operation. If the problems concerning transplantation immunity are solved, allograft hand transplantation will be an optimal method of functional reconstruction of hand defects.