Colgajo toracoabdominal para la cobertura de lesión traumática de mano / Thoracoabdominal flap for hand traumatic injury coverage

Es de gran importancia conocer las técnicas apropiadas para la restauración de las unidades funcionales de la mano a consecuencia de lesiones traumáticas, resguardando en lo posible su configuración y funcionalidad, puesto que desempeña múltiples tareas en distintos ámbitos de la vida. A continuación, se expone el caso de un paciente con lesión traumática por aplastamiento en mano derecha, cuyo tratamiento de consideración fue el colgajo toracoabdominal que fue llevado a cabo en tres tiempos, el paciente evolucionó de forma favorable sin complicaciones de infección, dehiscencia o necrosis del colgajo. A pesar de la introducción microquirúrgia para la reconstrucción de estas lesiones, los colgajos pediculados continúan siendo factibles con resultados óptimos en situaciones en las que la microcirugía no puede ser considerada. Si bien existen múltiples técnicas para la corrección de los defectos en mano, la habilidad y creatividad del cirujano siguiendo los principios básicos de la reconstrucción serán concluyentes para un resultado óptimo.

It is very important to know the appropriate techniques for the restoration of hand injuries, protecting as much as possible their configuration and functionality, since it performs multiple tasks in different areas of life. Hence, we present the case of a patient with traumatic injury due to crushing in the right hand, which treatment was considered the thoracoabdominal flap that was carried out in three times, the patient evolved favorably without complications of infection, dehiscence or necrosis of the flap. Despite the introduction of microsurgery for the reconstruction of these lesions, pedicle flaps continue to be feasible with optiomal results in situations in which microsurgery cannot be considered. Although there are multiple techniques for the correction of defects in hand, the skill and creativity of the surgeon following the basic principles of reconstruction will be conclusive for an optimal result.

Long-term Follow-up of Reconstruction of the Hand with a Temporoparietal Fascial Free Flap

PURPOSE: Soft tissue defect of the hand, which cannot be covered with skin graft or local flap, is usually reconstructed using a free flap. Temporoparietal fascial free flap is one of the best alternatives for functional reconstruction of the hand with exposed tendons, bones, and joints. MATERIALS AND METHODS: We have experienced four cases of reconstruction using a temporoparietal fascial flap with a skin graft and followed up for 20 years. We conducted a retrospective review of the patients' clinical charts and photos. RESULTS: At the time of initial injury, the average age of patients was 50.3 (39~62) years. The radial artery was used for reconstruction of the dorsal side of the hand, whereas the ulnar artery was used for that of the volar side of the wrist. Short term complication such as skin graft loss and donor site alopecia occurred. However, during the long term follow-up period, no change of flap volume was noted, and full range of motion in the adjacent joint was maintained. In addition, hyperpigmentation of the grafted skin on the flap disappeared gradually. CONCLUSION: Selection of the optimal flap is important for reconstruction of the hand without functional limitation. We obtained satisfactory soft tissue coverage and functional outcomes using a temporoparietal fascial free flap and followed up for 20 years.

Cirugía reconstructiva de la mano / Hand reconstruction surgery

La cirugía reconstructiva de la mano y el desarrollo de ésta, está ligada al de la microcirugía. Requiere del dominio de varias disciplinas y, por parte del equipo tratante, establecer una estrategia de tratamiento desde el principio. Ideal es realizar toda la reconstrucción en un tiempo para iniciar una movilización precoz. El debridamiento inicial se continúa con la reparación de todos los tejidos de la mano. La cobertura constituye otro paso importante y lo ideal es realizarla en la atención de urgencia. La mano debe iniciar su rehabilitación en forma inmediata ya que lo contrario llevará a la instalación de la rigidez. Cuando no ha sido posible dejar una pinza básica de la mano, la reconstrucción de ésta pasa por el uso de técnicas de transferencias de ortejos a mano. La transferencia del hallux y de otros ortejos hoy son ampliamente usados y con excelentes resultados funcionales.

Reconstructive surgery of the hand and its development, is linked to microsurgery. Requires the mastery of several disciplines, and by the medical treating team, establish a treatment strategy from the beginning. Ideal is to do all the reconstruction at a time to begin early mobilization. The initial debridement is continued with the repair of all tissues of the hand. The coverage is another important and ideally do it in emergency care. The rehabilitation of the hand should start immediately and that otherwise lead to the installation of rigidity. If it is not possible to leave a basic gripper hand, reconstruction of this happens by using transfer techniques from toes to hand. The transfer of the hallux and other toesare widely used today with excellent functional results.

Versatile Applications of Anterolateral Thigh Perforator Flap in the Reconstruction of Upper Extremity Defects: Retrospective Analysis of 119 Cases

PURPOSE: The perforator flaps have established their role in the reconstruction of various soft tissue defects. For the last five years, we have extensively used anterolateral thigh (ALT) flap for the reconstruction of the complex tissue defects of the hand and upper extremity and report the clinical results and our experiences with the versatile applications of this flap. MATERIALS AND METHODS: From March 2003 through May 2008, 119 free ALT perforator flaps were transferred for reconstruction of the complex tissue defects of the elbow, forearm, wrist and hand after crushing or degloving injuries as well as severe scar contractures. There were 95 females and 24 males. The mean age of the patients was 37 years and mean size of the flap was 170 cm(2). In 20 cases, the flap was vascularized by septocutaneous and in 99 cases by musculocutaneous perforators. Intra-muscular dissection length averaged 3.4 cm. The total length of pedicle averaged 8.4 cm and the average arterial diameter was 0.84 mm. End-to-end arterial anastomosis was performed in 103 cases and end-to-side in 16 cases. RESULTS: Flap survival rate was 98.3%(117/119) and there were 6 cases of partial necrosis. Donor site was closed primarily in 41 cases and skin grafts were applied in 78 cases. CONCLUSION: The reliability and versatility of ALT flap makes it one of the foremost choices for the reconstruction of complex tissue defects of the upper extremity.

Hand Reconstruction with Medial Sural Perforator Free Flap

PURPOSE: The main advantages of the perforator flap are minimal donor site morbidity, preservation of any main source artery and its thin characteristics. Most perforator flaps for hand reconstruction need primary and secondary procedures such as a flap debulkiness and liposuction etc. However, flap thickness of calf area is thinner than any other perforator flaps. METHODS: We performed an anatomical study and clinical application of medial sural artery perforator flap. We found that there are two or more medial sural perforators located on a straight line drawn from the mid-point of popliteal crease to the mid-point of medial malleolus. Most pathway of medial sural artery comes along with this line. It is possible to observe the first perforators almost exactly 8 cm from midpoint of popliteal crease in a distal half circle drawn with a radius of 2 cm. RESULTS: We report 12 cases in 11 patients of hand reconstruction with medial sural perforator free flap from Febrary 2003 to Febrary 2006. Complete healing was possible in 11 cases. Total flap loss for venous insufficiency was in 1 patient. During the follow-up, good contour and full range of motion was observed on hand reconstruction with medial sural perforator free flap. CONCLUSION: In the authors' experience, this anatomical study made it possible to prepare a diagram of the exact location of the medial sural perforators. This flap can be used to achieve acceptable functional and aesthetic results for hand reconstruction because of its thin characteristics.

Clinical Observation of the Neurovascular Island Pedicle Flap in the Hand / 대한정형외과학회잡지

The skin defects or sensory impairment of the fingers, especially at the critical area for prehension(tips of thumb, index and middle fingers) should be reconstructed for the better function of hand. In our department, we performed neurovascular island pedicle flap transfer for the purpose of reconstruction of sensibility and skin defect simultaneousely to the critical area. 1. Since 1978, we had performed neurovascular island pedicle flap transfer in 14cases, among which 9 cases were followed for more than one year. 2. The operation was performed for the reconstruction of thumb in 8 cases, and index in 4 cases. The most common cause of injury was crushing by machine(8 cases). 3. The island flap was transferred from middle finger(9 cases) and from ring finger(4 cases). 4. Recovery of the protective sensation at the recipient sites was good or fair after one year, but reorientation and two point discrimination were poor. 5. Cold intolerance was developed in 3 cases and callosity was formed in 2 cases. 6. In all cases, the transferred flaps were good in circulation status and durability. 7. It is considered that the neurovascular island pedicle flap is an accepted method of restoring skin coverage as well as sensation to a localized tactile area in the hand.