Forearm arterial loop as an expedient source for inflow to upper extremity free flaps

Microsurgery ◽  
1995 ◽  
Vol 16 (7) ◽  
pp. 445-449 ◽  
Author(s):  
Geoffrey G. Hallock
Keyword(s):  
Upper Extremity ◽  
Free Flaps

scholarly journals Comparison of Fasciocutaneous and Muscle-based Free Flaps for Soft Tissue Reconstruction of the Upper Extremity

2019 ◽  
Vol 7 (12) ◽  
pp. e2543
Author(s):  
Christoph Koepple ◽  
Ann-Katrin Kallenberger ◽  
Lukas Pollmann ◽  
Gabriel Hundeshagen ◽  
Volker J. Schmidt ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Upper Extremity ◽  
Free Flaps ◽  
Soft Tissue Reconstruction ◽  
Tissue Reconstruction

LATERAL ARM FREE FLAPS IN THE DEFECTS OF THE UPPER EXTREMITY — A REVIEW OF 72 CASES

Hand Surgery ◽  
2005 ◽  
Vol 10 (02n03) ◽  
pp. 177-185 ◽  
Author(s):  
M. Akinci ◽  
Ş Ay ◽  
S. Kamiloglu ◽  
Ö. Erçetin
Keyword(s):  
Venous Thrombosis ◽  
Upper Extremity ◽  
Failure Rate ◽  
High Voltage ◽  
Free Flaps ◽  
Perforator Flaps ◽  
Operative Duration ◽  
Anastomosis Site ◽  
Extended Approach ◽  
Forearm Skin

Lateral arm flaps are versatile in the use of upper extremity moderate-sized defects with little morbidity and with acceptable cosmesis. The conditions are outlined in a series of 74 lateral arm flaps performed on 72 patients and the results are given. Five patients were operated on as emergencies, 12 were operated within the first 72 hours of injury and 57 patients were treated electively. Skin defects were between 6 × 4 cm and 20 × 9 cm . Five (7%) flaps were lost due to venous thrombosis, three that sustained a high-voltage electric burn. Two other patients that were treated for a high-voltage electric burn had a successful revision of the anastomosis site in the early post-operative duration. One flap was abandoned due to very thin pedicle and obesity of the patient. A higher failure rate is encountered most frequently with the cases of high-voltage electric burn. To deal with this problem, a modified approach such as an extended approach and/or including the forearm skin to the flap is recommended during the flap harvest. For a longer pedicle to be anatomized more proximally, perforator flaps with longer pedicles may be used as an alternative.

scholarly journals Aesthetic and Functional Outcomes of the Innervated and Thinned Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Carlos Alberto Torres-Ortíz Zermeño ◽  
Javier López Mendoza
Keyword(s):  
Upper Extremity ◽  
Free Flaps ◽  
Sensory Function ◽  
Anterolateral Thigh Flap ◽  
Level Of Evidence ◽  
Average Percentage ◽  
Aesthetic Result ◽  
Anterolateral Thigh ◽  
Good Cosmetic ◽  
Alt Flap

Background. The anterolateral thigh (ALT) flap has been widely described in reconstruction of the upper extremity. However, some details require refinement to improve both functional and aesthetic results. Methods. After reconstruction of upper extremity defects using thinned and innervated ALT flaps, functional and aesthetic outcomes were evaluated with the QuickDASH scale and a Likert scale for aesthetic assessment of free flaps, respectively. Results. Seven patients with a mean follow-up of 11.57 months and average flap thickness of 5 mm underwent innervation by an end-to-end neurorrhaphy. The average percentage of disability (QuickDASH) was 21.88% with tenderness, pain, temperature, and two-point discrimination present in 100% of cases, and the aesthetic result gave an overall result of 15.40 (good) with the best scores in color and texture. Conclusions. Simultaneous thinning and innervation of the ALT flap lead to a good cosmetic result and functional outcome with a low percentage of disability, which could result in minor surgical procedures and better recovery of motor and sensory function. Level of Evidence. IV.

First Experience in Thoracoscopic Sympathectomy at Treatment of Patients with Vast Posttraumatic Upper Extremity Defects Using Free Flaps

2013 ◽  
Vol 20 (2) ◽  
pp. 69-73
Author(s):  
I. O Golubev ◽  
A. I Krupatkin ◽  
A. A Maximov ◽  
V. A Ruzmichev ◽  
M. V Merkulov ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Laser Doppler Flowmetry ◽  
Trophic Status ◽  
Free Flaps ◽  
Distal Region ◽  
Extremity Injury ◽  
Doppler Flowmetry ◽  
Thoracoscopic Sympathectomy ◽  
Clinical Observations ◽  
Upper Extremity Injury

Two clinical observations of patients with severe upper extremity injury sequelae are presented. Examinations included clinical and ultrasound methods, MRT-angiography, ENMG. Trophic status and microcirculation were studied using computer thermography as well as laser Doppler Flowmetry. Thoracoscopic clipping of sympathetic ganglions at the Th3-Th4 levels were performed in 7 weeks and 3 months following microsurgical forearm reconstruction. Sympathectomy provoked significant microcirculation activation and as a consequence improvement of extremity trophic status including distal region

scholarly journals Single Artery Upper Extremity Salvage with Two Free Flap End-to-Side Brachial Artery Anastomoses

2020 ◽  
Vol 05 (02) ◽  
pp. e57-e60
Author(s):  
Michael J. Stein ◽  
Jing Zhang
Keyword(s):  
Upper Extremity ◽  
Brachial Artery ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Free Flaps ◽  
Anterolateral Thigh Flap ◽  
No Donor ◽  
Recipient Site

Abstract Background A 36-year-old male was involved in a motor vehicle accident, presenting with a Guistillo's IIIB crush injury to the upper extremity. A severely comminuted ulnar fracture resulted in a 10-cm bone defect with significant overlying soft tissue injury. Methods The injury resulted in a wide zone of injury with inadequate collateral vascularity at the level of the elbow and distal viability dependent on the brachial artery. An osteocutaneous free fibular flap and fasciocutaneous anterolateral thigh flap were used to reconstruct the defect with both flaps anastomosed in an end-to-side fashion to the brachial artery. Results The upper extremity was successfully salvaged, and the patient discharged from hospital at postoperative day 10. Both free flaps survived with no donor or recipient site complications at a follow-up period of 2 years. Conclusion The case illustrates the challenges inherent to significant Guistillo's IIIB injuries with insufficient recipient vessels over a large zone of injury. While performing anastomoses outside the zone of injury is preferred, this case demonstrates the success of performing multiple anastomoses to the brachial artery in an end-to-side fashion within the zone of injury.

Monitoring for Upper-Extremity Free Flaps and Replantations

2008 ◽  
Vol 33 (10) ◽  
pp. 1905-1908 ◽  
Author(s):  
Karim Bakri ◽  
Steven L. Moran
Keyword(s):  
Upper Extremity ◽  
Free Flaps

A Retrospective Comparative Functional and Aesthetic Outcome Study of Muscle versus Cutaneous Free Flaps for Distal Upper Extremity Reconstruction

2021 ◽  
Author(s):  
Benjamin Thomas ◽  
Jan Warszawski ◽  
Florian Falkner ◽  
Sarah S. Nagel ◽  
Felix Vollbach ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Short Form ◽  
Hand Function ◽  
Donor Site ◽  
Free Flaps ◽  
Muscle Flaps ◽  
Sf 36 ◽  
Validation Score ◽  
Extremity Reconstruction

Abstract Background Function and cosmesis are crucial in upper extremity reconstruction. Yet, there persists a lack of outcome evaluations, particularly regarding differences between free flap types. Methods In a single-center retrospective analysis, outcomes were compared between patients with cutaneous or muscle free flaps for distal upper extremity reconstruction between 2008 and 2018. The Disabilities of Arm, Shoulder and Hand -Score, Michigan-Hand (MHQ), and Short Form 36 Health Survey (SF-36) Questionnaires were assessed, motor function was quantified, and self-reported measures of cosmesis were compared, including the Vancouver Scar-Scale (VSS), MHQ aesthetics-subscale (MAS), and Moscona's cosmetic validation-score (CVS). Results One-hundred forty-one cases were identified, with a shift toward cutaneous flaps over the study period. Muscle flaps were used for larger defects (251 vs. 142 cm2, p = 0.008). Losses, thromboses, and donor-site complications were equally distributed. Partial necroses were more frequent in muscle flaps (11 vs. 1%, p = 0.015). Seventy patients with 53 cutaneous versus 17 muscle flaps were reexamined. There was no difference in the timing of flap coverage (after 16 vs. 15 days, p = 0.79), number of preceding (2 vs. 1.7, p = 0.95), or subsequent operations (19/53 vs. 5/17, p = 0.77). Patients with cutaneous flaps showed higher grip strength (25 vs. 17 kg, p = 0.046) and reported better hand function (MHQ: 58 vs. 47, p = 0.044) and general health (SF-36: 70 vs. 61, p = 0.040), as well as more favorable appearance (MAS: 71 vs. 57, p = 0.044, CVS: 77 vs. 72, p = 0.048), and scar burden (VSS: 0 vs. 3, p < 0.001). Conclusion Cutaneous flaps yielded better motor function, self-perceived cosmesis, patient satisfaction, and quality of life in our cohort of distal upper extremity reconstructions.

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