Chimeric flap pedicled with superficial branch of superficial iliac circumflex artery in repair of soft tissue defects of dorsal hand and metacarpal bone / 中华显微外科杂志

Objective:To investigate the effect of chimeric flap pedicled with superficial branch of superficial iliac circumflex artery in repair of soft tissue defect of dorsal hand combined with metacarpal bone defect.Methods:From May 2015 to January 2022, 34 patients(28 males and 6 females) of soft tissue defects of dorsal hand with metacarpal bone defects were treated in the Department of Orthopedics of Yibin Third People's Hospital. The age of patients ranged from 22 to 51 years old, with an average age of 37 years old. The areas of soft tissue defects after debridement were 2.5 cm×5.0 cm-4.5 cm×9.0 cm, and the defects were all in dorsal hand and dorsal wrist. The lengths of metacarpal bone defect were 1.8-4.1 cm. All the patients had only single metacarpal bone defect, among which: 14 patients had defects in first metacarpal bone, 7 in second metacarpal bone, 4 in third metacarpal bone, 8 in fourth metacarpal bone and 1 in fifth metacarpal bone. All the patients were repaired by chimeric flap pedicled with superficial branch of superficial iliac circumflex artery. The size of flaps were 3.6 cm×5.4 cm-5.2 cm×9.5 cm. Anticoagulation, thermal preservation and plaster fixation were applied for 4-6 weeks after surgery. Postoperative follow-ups included regularly outpatient clinic visit, telephone or Wechat reviews. Follow-up items covered: the feeling and appearance of flaps in recipient sites, healing of the donor sites and recovery of hand functions.Results:All the 34 chimeric flaps survived. Regular follow-up lasted for 3 to 15(average, 10) months. All incisions in the donor sites of hip healed in stage I. TPD of the flaps was 5.1-7.3(mean, 6.4) mm. Appearance of flaps in the receiving area were satisfactory without swelling. Movement of wrists and metacarpophalangeal joints met the basic requirement of movement. The healing time of metacarpal defect was 2-3 months with an average of 2.8 months. Hand functions were evaluated at excellent in 6 patients and good in 28, according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Conclusion:The chimeric flap pedicled with superficial branch of superficial iliac circumflex artery is an ideal flap to repair the soft tissue defect in dorsal hand combined with metacarpal bone defect. It has advantages of less donor site damage, good blood supply of flap, simple surgical procedure, and one-stage repair of a combined soft tissue and metacarpal bone defects.

Effect of Cutaneous Never Anastomosis on Sensory Reconstruction in Free Anterolateral Femoral Flap Repairing Wide Spreadly Dorsal Hand Soft Tissue Defect / 中国康复理论与实践

@#Objective To explore the effect of cutaneous never anastomosis on sensory recovery in repairing wide spreadly soft tissue defects in dorsal hand with free anterolateral femoral flap. Methods The cases with wide spreadly soft tissue defects in dorsal hand repaired with free anterolateral femoral flap from January 2006 to December 2012 were divided into 2 groups. The control group including 15 consecutive patients from January 2006 to January 2009, whose sensation was reconstructed in routine way. Other 15 consecutive patients from Febnary 2009 to December 2012 were as research group, whose sensation was reconstructed with the suture of cutaneous nevers of anterolateral femoral flaps and forearm. All the patients were followed up for 12~24 months. Results All the free flaps survived in both groups. There were 4 cases good of sensory recovery in the control group, and it was 11 in the research group. No ulceration happened. Conclusion Cutaneous never anastomosis may result in satisfactory sensory function in the patients with wide spreadly soft tissue descts in dorsal hand repaired with free anterolateral femoral flap.

Effect of Cutaneous Never Anastomosis on Sensory Reconstruction in Free Anterolateral Femoral Flap Repairing Wide Spreadly Dorsal Hand Soft Tissue Defect / 中国康复理论与实践

Objective To explore the effect of cutaneous never anastomosis on sensory recovery in repairing wide spreadly soft tissue de-fects in dorsal hand with free anterolateral femoral flap. Methods The cases with wide spreadly soft tissue defects in dorsal hand repaired with free anterolateral femoral flap from January 2006 to December 2012 were divided into 2 groups. The control group including 15 consec-utive patients from January 2006 to January 2009, whose sensation was reconstructed in routine way. Other 15 consecutive patients from Febnary 2009 to December 2012 were as research group, whose sensation was reconstructed with the suture of cutaneous nevers of anterolat-eral femoral flaps and forearm. All the patients were followed up for 12~24 months. Results All the free flaps survived in both groups. There were 4 cases good of sensory recovery in the control group, and it was 11 in the research group. No ulceration happened. Conclusion Cutaneous never anastomosis may result in satisfactory sensory function in the patients with wide spreadly soft tissue descts in dorsal hand repaired with free anterolateral femoral flap.

One-stage reconstruction of dorsal hand soft-tissue defects with tendon allograft and free anterolateral thigh flaps / 中华显微外科杂志

Objectives To evaluate the clinical effect of one-stage reconstruction of dorsal hand softtissue defects using tendon allograft and free anterolateral thigh flaps.Methods From July 2006 to July 2011,fifteen cases of complex soft-tissue defects in dorsal hands were repaired using tendon allografts and anterolateral thigh flaps,sizing from 9 cm ×5 cm to 14 cm× 11 cm,in one stage.Two to 4 digital extensor tendons were reconstructed.With a brace on,early finger exercises were started after 2 weeks postoperatively when the flaps had survived.Results All the 15 flaps survived uneventfully.Twelve of the 15 patients were available for follow-up from 12-24 months (averaged 16 months).Two cases received tendolysis due to poor finger movement 6 moths postoperatively.At the end of follow-up,the range of wrist joint active flexion is from 40 to 70degrees and extension is from 25 to 50 degrees.The motion range of the related metacarpophalangeal joints was from 60 to 85 degrees,that of the interphalangeal joints from 80 to 90 degrees.The overall effective rate was 92 percent.Conclusion Simultaneous composite repair using tendon allografts and skin flaps proved to be reliable and cost-effective for complex dorsal hand soft-tissue defects.Allograft tendon reconstruction can not only obliterates new morbidities of autografting but also facilitates timely rehabilitation,avoiding extension loss of hand joints.

Neutrophilic Dermatosis of the Dorsal Hands / 대한피부과학회지

Neutrophilic dermatosis of the dorsal hands (NDDH) is a rare, localized variant of Sweet syndrome, and it was first described by Galaria et al. in 2000. It usually occurs in middle-aged women and it is characterized by erythematous papules, plaques, pustules and hemorrhagic bullae that are generally located on the dorsal hands. The histopathological findings show prominent papillary dermal edema and a dense dermal neutrophilic infiltration. A neutrophilic infiltrate can also cause a variable degree of vascular damage: endothelial cell swelling, RBC extravasation, leukocytoclasia and fibrin deposition within the walls of vessels. We report here on a case of NDDH in a 50-year-old man who was treated with oral corticosteroid and the NDDH recurred after 9 months.

A Case of Neutrophilic Dermatosis of the Dorsal Hands with Concomitant Involvement of the Lips

Neutrophilic dermatosis of the dorsal hands (NDDH) is a localized, pustular variant of acute febrile neutrophilic dermatosis (Sweet syndrome). The lesions of NDDH clinically resemble those of Sweet syndrome (SS), but they differ from classic SS according to their locations (NDDH is predominantly restricted to the dorsal hands) and the smaller number of accompanying systemic symptoms. The histology of the NDDH lesion shows a dense dermal neutrophilic infiltration. The lesions rapidly resolve after systemic corticosteroid and/or dapsone therapy. We herein report on a case of neutrophilic dermatosis of the dorsal hands in a 34-year-old woman. The patient also had skin changes with erythematous plaque on the right lips.

Clinical Experiences in Management of the Extensive Flame Burns Dorsal Hand by Early Excision and Graft

This study was carried out to examine the effect of early excision and graft for the preservation of the maximal function on the dorsal hand with deep second degree and third degree flame burns. From December 1996 to October 1998, 11 flame burn patients admitted to our hospital burn unit. Nine patients had injured burns less than 20% Total Burn Surface Area, and 2 patients were 70% Total Burn Surface Area(mean 18.4%). We had performed the excision 3-8 days(mean 4.6 days) after burn injury. Ten (90.9%) of eleven patients survived, and 1 patient (Total Burn Surface Area 70%) died of sepsis after early excision. The duration of immobilization was 8-17 days (mean 11.5 days). Twelve months later, the range of motion in all patients has been continued to maintain nearly normal range of motion. We conclude that early excision and grafting was recommended as the preferred form of treatment in patients with deep second degree and third degree on the extensive flame burns of dorsal hand.