Free Flaps in the Reconstruction of Hand and Distal Forearm Injuries

1992 ◽  
Vol 17 (2) ◽  
pp. 185-188 ◽  
Author(s):  
A. REIGSTAD ◽  
K. R. HETLAND ◽  
K. BYE ◽  
M. RØKKUM
Keyword(s):  
Donor Site ◽  
Hand Surgery ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Medium Size ◽  
Nerve Grafts ◽  
Partial Necrosis ◽  
Tendon Grafts ◽  
Large Skin ◽  
Forearm Injuries

We report a series of 32 free flap reconstructions following acute hand and forearm trauma. The series consists of two dorsalis pedis flaps, four scapular flaps and 26 lateral arm flaps. One flap became infected and failed completely, and a partial necrosis occurred in another flap. The transfers covered large skin defects, exposed tendons, tendon grafts, bone, bone grafts, joints, nerves and nerve grafts. The donor site morbidity was negligible. Our study shows that free microvascular flaps are a safe and convenient alternative to conventional flaps in hand surgery. The lateral arm flap seems very suitable for small and medium size defects.

scholarly journals Suprafascial Free Flaps: Classification and Comprehensive Review of the Literature

2021 ◽  
Vol 6 ◽  
pp. 247275122110205
Author(s):  
Sebastian Rios ◽  
María Isabel Falguera-Uceda ◽  
Alicia Dean ◽  
Susana Heredero
Keyword(s):  
Survival Rate ◽  
Preoperative Planning ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Anterolateral Thigh Flap ◽  
Cochrane Library ◽  
Review Of The Literature ◽  
Comprehensive Review ◽  
Search Terms

Study Design: Suprafascial free flaps have become common place in reconstructive surgery units. Nomenclature related to these flaps has not been uniform throughout the scientific literature, especially in regard to planes of dissection. This study is designed as a comprehensive review of the literature. Objectives: Our study highlights which flaps are used most frequently, their main indications, their survival rate, and how they have evolved in the last few decades as innovations have been introduced. Methods: A review of the literature was performed using keywords and Medical Subject Headings search terms. PubMed, Embase, and Cochrane Library were searched using the appropriate search terms. Data collected from each study included flap type, dissection plane, preoperative planning, area of reconstruction, as well as complications, donor-site morbidity and survival rate. Results: Seven hundred and fifty-five studies were found based on the search criteria. After full-text screening for inclusion and exclusion criteria 34 studies were included. A total of 1332 patients were comprised in these studies. The most common types of flaps used were superficial circumflex iliac perforator flap (SCIP), anterolateral thigh flap (ALT), and radial forearm flap. The most common areas of reconstruction were head & neck and limbs. There was no significant difference in survival rates between flaps that were raised in different planes of dissection. Conclusions: Based on the author’s review of the literature, suprafascial flaps are reliable, they have low donor site morbidity, and there is a wide selection available for harvest. The use of new technologies for preoperative planning, such as CT-Angiography and UHF ultrasound, have contributed to have more predictable results. We propose a standardized classification for these flaps, in order to create a uniform nomenclature for future reference.

Segmental Defects in Peripheral Nerves Xenotransplantation

2018 ◽  
Vol 2 (5) ◽  
pp. 01-02
Author(s):  
Ryan William
Keyword(s):  
Graft Rejection ◽  
Peripheral Nerves ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Clinical Use ◽  
Nerve Grafts ◽  
Surgery Research ◽  
The Ideal

Segmental defects in peripheral nerves that cannot be sutured directly require the use of nerve grafts. The ideal option for repair is nerve auto grafting, but there are some obvious disadvantages related to its use, such as lack of availability and donor site morbidity. The next step to consider for reconstruction is the use of nerve allografts, but they are also limited for clinical use, and they present with the added problem of graft rejection. Considering these limitations to the use of nerve autografts and allografts, clinical surgery research has turned to nerve xenotransplantation, which offers a potentially unlimited source of donor nerves.

Comparison of sub- versus suprafascially raised anterolateral thigh free flaps with regard to donor-site morbidity, function and aesthetics

Microsurgery ◽  
2017 ◽  
Vol 38 (5) ◽  
pp. 444-449 ◽  
Author(s):  
Sebastian Fischer ◽  
Yannick Diehm ◽  
Christoph Hirche ◽  
Thomas Kremer ◽  
Adrien Daigeler ◽  
...  
Keyword(s):  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Anterolateral Thigh

The Role of Free Flaps in the Treatment of Persistent Scalp Osteomyelitis

2006 ◽  
Vol 59 (suppl_1) ◽  
pp. ONS-64-ONS-67 ◽  
Author(s):  
Willy D. Boeckx ◽  
René R.W.J. van der Hulst ◽  
Lloyd V. Nanhekhan ◽  
Francesca De Lorenzi
Keyword(s):  
Free Flap ◽  
Donor Site ◽  
Muscle Flap ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Surgical Debridement ◽  
Neurosurgical Procedures ◽  
Latissimus Dorsi Muscle Flap ◽  
Flap Transfer ◽  
Free Flap Transfer

Abstract OBJECTIVE: To evaluate the efficacy of the combination of an extensive surgical debridement and simultaneous free flap repair in case of troublesome cranial osteomyelitis. METHODS: Five patients with persistent, frontal bone osteomyelitis were treated with surgical debridement of the infected bone and reconstruction with a free flap. In all patients, osteomyelitis occurred after neurosurgical procedures and lasted from 1 to 7 years. A latissimus dorsi muscle flap with a split skin graft has been performed. RESULTS: No flap failure occurred and donor site morbidity was negligible. No signs of osteomyelitis or soft tissue infection were observed during the mean follow-up period of 3.2 years. Furthermore, the contour of the cranium could be preserved without a need for bone grafts or implants. CONCLUSION: In our experience, the combination of an extensive surgical debridement and a free flap transfer is demonstrated to be an effective treatment for “chronic” osteomyelitis of the cranium.

scholarly journals Sole Reconstruction Using Anterolateral Thigh Free Flap: A Review of 4 Cases

1970 ◽  
Vol 2 (3) ◽  
Author(s):  
Parintosa Atmodiwirjo ◽  
Afriyanti Sandhi
Keyword(s):  
Free Flap ◽  
Weight Bearing ◽  
Donor Site ◽  
Three Dimensional ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Common Procedure ◽  
Anterolateral Thigh ◽  
Protective Sensation ◽  
And Function

Background: The ideal technique for sole reconstruction should meet such requisite as a durable and comfortable weight-bearing surface, solid anchoring to deep tissue for resistance to shear force and adequate protective sensation. The anterolateral thigh (ALT) perforator free flap provides a large, pliable skin island and sufficient bulk, allowing three-dimensional tailoring to complex defects. The present article is about our experience of sole reconstruction ALT perforator free flap. Patient and Method: Total of 4 flaps in the foot defects was performed in February 2009 to December 2012. We reconstructed soft tissue defects in the sole using ALT free flaps, the complications, aesthetic and function results were monitored. Result: ALT perforator free flap provided stable and durable long-term wound cover in all patients, resulting in early rehabilitation and function outcomes were completely achieved. Complications were few and manageable in all cases. Summary: ALT perforator free flap has become common procedure in many centers around the world. The numerous advantages include stable wound coverage; improve aesthetic and functional outcomes, and minimal donor site morbidity. In our experiences, we found that the use of ALT perforator free flap in sole defect reconstruction, to be technically affordable, reliable and have resulted in excellent outcomes.

scholarly journals Double free-flap for a bimalleolar defect of lower leg and ankle

2016 ◽  
Vol 49 (01) ◽  
pp. 95-98
Author(s):  
Naren Shetty ◽  
Narendra S. Mashalkar ◽  
Sunder Raj Ellur ◽  
Karishma Kagodu
Keyword(s):  
Donor Site ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Lower Leg ◽  
Donor Site Morbidity ◽  
The Other ◽  
Limb Ischaemia ◽  
Distal Limb ◽  
Limb Defects ◽  
Recipient Vessel

ABSTRACTDouble free-flaps are necessary when tissue cover cannot be sufficed with a single flap. The other factors to be considered when using two free flaps for resurfacing of distal limb defects are the availability of more than one recipient vessel, the risk of distal limb ischaemia and the donor site morbidity of double flap harvest. If these factors are adequately addressed, double free-flaps can be safely executed for resurfacing distal limb defects with minimal morbidity. We report the simultaneous harvest and transfer of the anterolateral and anteromedial thigh flaps inset and vascularised as double free-flaps to resurface a large bimalleolar defect in a 14-year-old boy with no additional morbidity as compared to that of a single free tissue transfer.

Comparing donor site morbidity between radial and ulnar forearm free flaps: a meta-analysis

2021 ◽  
Author(s):  
Qiang Xu ◽  
Peng-Li Chen ◽  
Yi-Hao Liu ◽  
Si-Min Wang ◽  
Zhong-Fei Xu ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity

Evaluation of Fingertip Injuries and Modalities of Flap Coverage in the Emergency Settings: A Retrospective Study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Salah Nasser Mohamed ◽  
AbdelRahman AbdeIAal ◽  
Mina Agaiby Estawrow ◽  
Andrew Adel Wassef Attia
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Joint Stiffness ◽  
Skin Grafting ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
University Hospitals ◽  
Maximum Function ◽  
Reconstruction Methods

Abstract Background Fingertip comprises the nail complex and glabrous pulp, which is richly vascularized and innervated, built around the distal phalanx. The fingertip is commonly affected because it is the most distal part of the hand so it's easily to be injured during athletic participation, occupational activities or in accidents. Various fingertip reconstruction methods are reported as healing by secondary intention, shortening and primary closure, skin grafts and flaps. Flaps are considered when there's a big soft tissue loss or an exposed bone. Complications of fingertip reconstructions are common such as flexion deformity and neuroma. Objective In this study, we assessed and compared the outcomes of different modalities of soft tissue covemge using different flap techniques in cases of fingertip injuries as regalding the incidence of neuroma, necrosis, donor site morbidity, joint stiffness and sensory impairment, together with the patient satisfaction. Patients and Methods We analyzed a retrospective cohort study of 90 patients with 96 fingertip injuries who underwent coverage by various flap techniques at Ain Shams University Hospitals in the period between July 2017 and July 2019. Results The V-Y Advancement flap and the Cross-finger flap were the commonest flaps done in 26 cases (27.1%) and 25 cases (26.0%) respectively. There's a highly statistically significance in the incidence of necrosis in abdominal flap (100%) followed by Moberg flap (46.2%). In addition, there is a statistically significance in the incidence of neuroma in Moberg flap (53.8%). Most of patients who underwent coverage by flap technique were very satisfied by the results (60.4%). Conclusion Many techniques have been described for reconstruction of fingertip trauma including revision amputation, skin grafting, local flaps, distant flaps and free flaps. The treatment choice depends on many factors such as patient preference, culture, resources available and surgeon skills. The goals of reconstruction in fingertip amputations are to cover the defect with a satisfactory cosmetic appearance, establish maximum function and preservation of sensation.

Microsurgical Scalp Reconstruction: An Overview of the Contemporary Approach

2021 ◽  
Author(s):  
Ping Song ◽  
Lee L. Q. Pu
Keyword(s):  
Preoperative Evaluation ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Primary Role ◽  
Recipient Site ◽  
Recipient Vessel ◽  
Scalp Reconstruction ◽  
Core Concepts ◽  
Contemporary Approach

Abstract Background Microsurgical scalp reconstruction has evolved immensely in the last half-century. The core concepts of microsurgical scalp reconstruction have always been to transfer soft tissue of a sufficient quality to within the defect while minimizing donor site morbidity. Refinements in scalp reconstruction consist of both improvement in reducing donor site morbidity and enhancing recipient site contour and balance. Furthermore, technical advancements and the vast experience within our field have allowed for preoperative evaluation of recipient vessels that are more favorable in proximity to the scalp. Methods In this review, we aim to describe the contemporary approach to microsurgical scalp reconstruction. This is to include the indications of choosing free flaps as well as how to select the ideal flap based on patient-oriented factors. The need for cranioplasty, recipient vessel selection, operative technique, and reoperations is also reviewed. In addition, our considerations and the nuances within each category are also described. Summary Scalp reconstructions involve the fundamental tenants of plastic surgery and demand application of these principles to each case on an individual basis and a successful reconstruction must consider all aspects, with backup options at the ready. Two workhorse free flaps, the anterolateral thigh perforator and latissimus dorsi muscles flaps, serve a primary role in the contemporary approach to microsurgical scalp reconstruction. Conclusion We hope this review can lay the foundation for which future plastic surgeons may continue to build and advance the approach to complex microsurgical scalp reconstruction.

REVISITING SUPRACLAVICULAR ARTERY FLAP FOR HEAD AND NECK ONCOLOGIC RECONSTRUCTION.

2021 ◽  
pp. 220-222
Author(s):  
Pranay Bhandari ◽  
Ameya Bihani ◽  
Pratiksha Pawar
Keyword(s):  
Prospective Study ◽  
Head And Neck ◽  
Buccal Mucosa ◽  
Gold Standard ◽  
Donor Site ◽  
Wound Dehiscence ◽  
Donor Site Morbidity ◽  
Partial Necrosis ◽  
Pros And Cons ◽  
A Prospective Study

Background: Head and neck oncologic resections defects are often difcult to reconstruct and are time consuming. An ideal ap should have qualities of both regional and free ap. Our aim in this study is to compare pros and cons of supraclavicular artery ap in comparison to other available ap. This report is a prospective study of cases that underwent supraclavicular artery ap of which, 5 are males and 3 are females. All cases were of carcinoma of Buccal mucosa. 5 cases were completely successful with no complication. One patient had partial necrosis, o Result: ne another patient had distal marginal necrosis with wound dehiscence and one patient had pus discharge with wound dehiscence and orocutaneous stula. No signicant donor site morbidity is seen. This ap has potential to Conclusion: become gold standard in reconstruction of head and neck defects.

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