Colgajo adipofascial de flujo reverso del dorso del antebrazo para reconstrucción de la mano y muñeca: nuestra experiencia clínica / Back Forearm Reverse Flow Adipofascial Flap for hand and wrist reconstruction: our clinical experience

Los defectos cutáneos de la mano pueden ser difíciles de resolver. La cobertura cutánea es esencial para proveer una protección adecuada y permitir el funcionamiento correcto de las estructuras subyacentes. El objetivo de este estudio es reportar nuestra experiencia con el uso del colgajo adipofascial de flujo reverso del dorso del antebrazo para cobertura del dorso de la mano, dedos y muñeca en pacientes tratados en la ciudad de San Cristóbal, Estado Táchira, desde mayo de 2015 hasta enero de 2018. Se realizó un estudio longitudinal, descriptivo y prospectivo en pacientes con pérdidas cutáneas extensas de la mano, que fueron cubiertas con el colgajo adipofascial reverso del dorso del antebrazo. Se incluyeron 10 pacientes. 90% de sexo masculino. La edad promedio fue 41±12,32(13-69). La etiología de los defectos fue: 40% traumatismos de alta energía, 30% mano diabética tropical, 10% secuela de quemadura de segundo grado, 10% herida por arma de fuego artesanal, 10% carcinoma primario de piel. 100% de los colgajos sobrevivieron, logrando buena cobertura y cicatrización sin necesidad de otros procedimientos quirúrgicos y con mínimas complicaciones de la zona dadora. La función de la mano y muñeca se recuperó en todos los pacientes. En conclusión, el colgajo adipofascial de flujo reverso del antebrazo es un procedimiento útil, versátil y sencillo para la reconstrucción del dorso de la mano, dedos y cara volar de muñeca en pacientes de distintas edades(AU)

Hand skin defects can be difficult to resolve. Skin coverage is essential to provide adequate protection and allow proper function of the underlying structures. The objective of this study is to report our experience with the use of the Back Forearm Reverse Flow Adipofascial Flap to cover the back of the hand, fingers and wrist in patients treated in the city of San Cristóbal, Táchira State, since may 2015 to january 2018. A longitudinal, descriptive and prospective study was made in patients with extensive skin losses of the hand, which were covered with the Back Forearm Reverse Flow Adipofascial Flap. 10 patients were included. 90,0% male. Mean age 41±12.32(13-69) years. The etiology of the defects was: 40,0% high-energy trauma, 30,0% tropical diabetic hand, 10,0% second degree burn sequel, 10,0% handcrafted firearm wound, 10,0% primary skin carcinoma. 100,0% of the flaps survived, achieving good coverage and healing without the need for other surgical procedures and with minimal complications in the donor area. Hand and wrist function recovered in all patients. In conclusion, the reverse flow adipoascial flap of the forearm is a useful, versatile and simple procedure for the reconstruction of the back of the hand, fingers and volar face of the wrist in patients of different ages(AU)

Prevalence of Complications after Limberg Rhomboid Flap in Patients with Cutaneous Defects at A Tertiary Care Hospital.

INTRODUCTION: Limberg rhomboid flap is an extremely useful and versatile technique to cover the cutaneous defects in various anatomical locations of different etiology and varied sizes. The main aim of the study is to find the prevalence of complications after limberg rhomboid flap in patients with cutaneous defects at a tertiary care hospital. METHODS: This descriptive cross-sectional study was conducted at a tertiary care hospital from October 2015 to November 2018 after obtaining approval from the institutional review committee. Study population is patient admitted to ward and outpatient department of surgery. Convenience sampling was done. Data was entered and analyzed in statistical package for social sciences and point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: Out of total patients, the complications were seen in total 8 (15.7%) patients. Prevalence of complications is 8 (15.7%) at 95% confidence interval (7.85-23.56). Among which, complications were seen in 5 (9.8%) bed sore, 2 (3.92%) in pilonidal sinus, 1 (1.96%) in traumatic ulcer and none in neoplastic lesion and types of complications seen were wound gaping in 3 (5.88%) cases, surgical site infection in 2 (3.92%) cases, recurrent pilonidal sinus in 1 (1.96%) case, flap necrosis in 1 (1.96%) case and epidermolysis in 1 (1.96%) case. CONCLUSIONS: The Limberg rhomboid flap can be used safely in patients with cutaneous defect with minimal complications and good surgical outcome however prevalence of complications after limberg rhomboid flap in patients with cutaneous defects at tertiary care center is high compared to the previous studies done.

Reconstruction of Mohs Defects of the Lips and Chin.

Reconstruction of defects of the lips after Mohs micrographic surgery should encompass functional and aesthetic concerns. The lower lip and chin compose two-thirds of the lower portion of the face. The focus of this article is local tissue transfer for primarily cutaneous defects after Mohs surgery. Various flaps exist for repair. For small defects, elliptical excision with primary closure is a viable option. During reconstruction of the lip, all of the involved layers need to be addressed, including mucosa, muscle, and the vermillion or cutaneous lip. It is especially important to realign the vermillion border precisely for optimal results.

Effect of vacuum sealing drainage in dermatoplasty of large area of cutaneous defects.

OBJECTIVES: To investigate the clinical effect of vacuum sealing drainage in dermatoplasty of large area of cutaneous defects in comparison to conventional treatment. METHODS: 80 patients with large area of cutaneous defects were enrolled in this study, and they had received superficial thickness dermatoplasty. Then these patients were randomly divided into two groups based on follow-up treatments: vacuum sealing drainage (defined as group A, 40 cases) and conventional treatment (defined as group B, 40 cases). After operation, all the patients received similar hospital stay, antibiotics administration, swelling elimination and wound closure in these two groups. RESULTS: No significant difference was observed in terms of the baseline characteristics between the two groups, including areas of cutaneous defects. Compared with conventional treatment group, the healing time of dermatoplasty was reduced significantly in vacuum sealing drainage group. Meanwhile, the rate of survival of dermatoplasty was better, and the rate of wound infection was lower in vacuum sealing drainage group than conventional treatment group. CONCLUSION: Vacuum sealing drainage is effective in treatment with large area of cutaneous defects combined with dermatoplasty, which had better clinical outcomes than conventional therapy.

The clinical application of the vacuum sealing drainage technology in the dermatoplasty for large area of cutaneous defects / 中国综合临床

Objective To explore the value of the use of the vacuum sealing drainage technology (VSD) in the dermatoplasty for large area of cutaneous defects.Methods By a prospective randomized study,64 patients with large area of cutaneous defects were randomly divided into traditional packaging group (dermatoplasty with the traditional dermatoplastic package method,n =32) and VSD group( dermatoplasty with the vacuum sealing drainage technology,n =32).Operating time,survival.rate of skin graft and wound infection were compared between these two groups.Results There was no significant difference in the operation time between the two groups( [77 ± 16]min vs [83 ± 12] min,P =0.06).The survival rate of skin graft and wound infection in VSD group were significantly better than those in traditional packaging group( survival rate of skin graft:(6±1)％ vs (20±7)％,P＜0.001;wound infection cases:1 vs6,P=0.039).Conclusion Treating large area of cutaneous defects by the dermatoplasty with VSD technology could significantly improve clinical efficacy.