A Comparative Study of the Heterodigital Neurovascular Island Flap in Thumb Reconstruction, with and without Nerve Reconnection

41 heterodigital neurovascular island flaps were used to cover defects of the tactile pad of the thumb in 17 years. With an average follow-up of 75.5 months, 30 patients were reviewed. 17 were treated by the original Littler technique and 13 were treated with the same flap reconstruction but with division of the digital nerve innervating the flap and re-anastomosis of this nerve to the proximal nerve end of the ulnar digital nerve of the thumb. Good aesthetic and functional results were achieved in both groups. Sensory acuity did not appear to decrease with time. The nerve reconnection technique solves the “double sensibility” phenomenon (present in 41.1% of our cases treated by the original technique), but two-point discrimination is less than that achieved by the Littler technique. Most complaints were related to the donor site such as hypertrophic scarring or scar contracture and cold intolerance, but these did not cause any real functional impairment.

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Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology

Foot & Ankle Orthopaedics ◽

10.1177/2473011419884269 ◽

2019 ◽

Vol 4 (4) ◽

pp. 247301141988426 ◽

Cited By ~ 1

Author(s):

John T. Stranix ◽

Merisa L. Piper ◽

Said C. Azoury ◽

Geoffrey Kozak ◽

Oded Ben-Amotz ◽

...

Keyword(s):

Free Flap ◽

Femoral Condyle ◽

Donor Site ◽

Case Series ◽

Medial Femoral Condyle ◽

Flap Reconstruction ◽

Foot And Ankle ◽

Osseous Union ◽

Vascularized Bone

Background: Complex hindfoot pathology may benefit from vascularized bone flap reconstruction rather than traditional bone grafting techniques. Medial femoral condyle (MFC) flaps provide vascularized periosteum, skin, and corticocancellous bone. Methods: A retrospective, single-institution cohort study of consecutive MFC flaps performed for complicated hindfoot reconstruction between 2013 and 2019 was reviewed. Radiologic follow-up assessed osseous union and clinical outcomes were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Thirty MFC flaps were performed in 28 patients for complex hindfoot pathology. Twenty-seven flaps had adequate clinical and radiographic follow-up (mean 15.8 months). Results: The majority presented with avascular necrosis (83%) and failed prior operations (67%, mean 3.1). Most hindfoot procedures involved arthrodesis (n = 24, 80%); tibiotalocalcaneal (n = 11) and talonavicular (n = 7) most frequently. Mean osseous flap volume was 10.3 cm3 (range 1.7-18.4 cm3); one flap required takeback for venous congestion but no total flap losses occurred. Primary osseous union was initially achieved in 20 patients (74%, mean 217 days). Six flaps developed interface nonunion; 5 underwent revision arthrodesis and ultimately achieved union in 24/27 flaps (89%, mean 271 days). Risk factors for nonunion were body mass index (BMI) >30 ( P = .017) and prior arthrodesis ( P = .042). Mean AOFAS hindfoot scores increased significantly from 52.3 preoperatively to 70.7 postoperatively ( P < .001). Subscore analysis demonstrated significant improvement in postoperative pain scores from 14.2 to 27.3 out of 40 ( P < .001). Conclusion: The MFC free flap provided vascularized bone for complicated foot and ankle reconstruction with relatively low donor site morbidity, promising osseous union results, and improved functional outcomes. Level of Evidence: Level IV, retrospective case series.

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Modified Littler flap for sensory reconstruction of large thumb pulp defects

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417754191 ◽

2018 ◽

Vol 43 (5) ◽

pp. 546-553 ◽

Cited By ~ 3

Author(s):

Hui Wang ◽

Xiaoxi Yang ◽

Chao Chen ◽

Bin Wang ◽

Wei Wang ◽

...

Keyword(s):

Donor Site ◽

Ring Finger ◽

Middle Finger ◽

Donor Site Morbidity ◽

Digital Nerve ◽

Level Of Evidence ◽

Dorsal Branch ◽

Ulnar Aspect ◽

Monofilament Test

The Littler flap has been widely used to repair large pulp defects of the thumb; however, several complications have occurred frequently. In order to reduce these issues, the modified Littler flap innervated by the dorsal branch of the proper digital nerve and the proper digital nerve from the ulnar aspect of the middle finger or the radial aspect of the ring finger were devised in 16 consecutive cases. At the donor site, the defect of the proper digital nerve was repaired with a nerve graft from the proximal portion of the ipsilateral dorsal branch of the proper digital nerve. At the final follow-up, the scores for the static two-point discrimination test, Semmes–Weinstein monofilament test and total active motions in both recipient and donor fingers were nearly normal. This modified Littler flap provides a simple and reliable alternative for treatment of large defects of the thumb pulp with low donor-site morbidity. Level of Evidence: IV

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Does nerve repair influence the outcome of reconstruction of a digital nail defect using a free composite flap taken from the great toe?

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193414532806 ◽

2014 ◽

Vol 40 (6) ◽

pp. 583-590 ◽

Cited By ~ 1

Author(s):

X. Zhang ◽

C. Chen ◽

Y. Li ◽

X. Shao ◽

W. Guo ◽

...

Keyword(s):

Nerve Repair ◽

Donor Site ◽

Digital Nerve ◽

Great Toe ◽

Dorsal Branch ◽

Mean Size ◽

The Mean ◽

Repair Group ◽

Composite Flap

We describe reconstruction of a nail unit defect in the finger using a free composite flap taken from the great toe, comparing the outcome in patients in whom neurorrhaphy between the dorsal digital nerve of the great toe and the dorsal branch of the proper digital nerve of the injured finger was performed to those in which no nerve repair was made. From January 2002 to March 2009, 47 patients with traumatic fingernail defects were treated. Twenty-two patients before February 2005 had no nerve repair and subsequently 25 patients had nerve repair. The mean size of the germinal matrix and sterile matrix defects was 9 × 8 mm, and the mean size of the nail bed flaps was 9 × 9 mm. The mean length of the arteries used for the flap was 2.2 cm. Outcomes were rated. In the nerve repair group, full flap survival was achieved in 24 patients. At the mean follow-up period of 25 months, there were 12 excellent, seven very good, four good, and two fair results. In the comparison group without nerve repair, there were seven excellent, four very good, four good, five fair, and two poor results. Donor site morbidities were similar in both groups. The use of a free composite flap taken from the great toe is a useful technique for reconstructing nail unit defects in the finger. Innervated nail flap reconstructions tended to show better outcomes than those in which no nerve repair was performed. There is no difference in function or donor site between those in whom the nerve was repaired compared with those in whom it was not repaired.

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Composite Osteocutaneous Groin Flap Combined with Neurovascular Island Flap for Thumb Reconstruction

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(02)00277-2 ◽

2003 ◽

Vol 28 (5) ◽

pp. 399-404 ◽

Cited By ~ 6

Author(s):

F. PARMAKSIZOGLU ◽

T. BEYZADEOGLU

Keyword(s):

Bone Resorption ◽

Functional Results ◽

Metacarpophalangeal Joint ◽

Island Flap ◽

Bone Block ◽

Thumb Reconstruction ◽

Groin Flap ◽

Three Phase ◽

Bone Scans

Three amputated thumbs were reconstructed with a composite osteocutaneous groin flap and a neurovascular island flap. The average age at the time of surgery was 28 (range 25–35) years. The level of the amputation was distal to metacarpophalangeal joint in two cases and proximal in one case. The injury mechanism was avulsion in all cases. The postoperative follow-up periods ranged from 27 to 30 months. There were no cases of skin necrosis, bone resorption or infection. Radiographs and three-phase bone scans showed union of the iliac bone block and the stump without any resorption in all three patients. This surgical procedure is reliable and simple and the functional results are satisfying. We reserve this technique for the treatment of thumb amputations which cannot be replanted, particularly as it does not result in bone resorption.

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First dorsal metacarpal artery flap with dorsal digital nerve with or without dorsal branch of the proper digital nerve produces comparable short-term sensory outcomes

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02838-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Shi-Ming Feng ◽

Jia-Ju Zhao ◽

Filippo Migliorini ◽

Nicola Maffulli ◽

Wei Xu

Keyword(s):

Patient Satisfaction ◽

Digital Nerve ◽

Reconstruction Procedure ◽

Level Of Evidence ◽

Cold Intolerance ◽

Dorsal Branch ◽

Dorsal Metacarpal Artery ◽

Retrospective Comparative Study ◽

First Dorsal Metacarpal Artery

Abstract Background The first dorsal metacarpal artery flap, including dorsal digital nerves with or without dorsal branches of the proper digital nerves, can be used to reconstruct thumb pulp defects with good results. However, it is still unclear whether there are differences in the sensory outcomes between preserving or not preserving the dorsal branches of the proper digital nerves. Methods This retrospective cohort study included 137 thumb pulp defect patients who underwent first dorsal metacarpal artery flap reconstruction procedure from October 2015 to June 2019. Patients were divided into two groups according to whether the dorsal branches of the proper digital nerves were preserved. In the non-preservation group (n = 80), the dorsal digital nerves were included in the flap for sensory reconstruction. In the preservation group (n = 57), the dorsal digital nerves and the dorsal branches of the proper digital nerves of the index finger were included in the flap. The stump of the proper digital nerves in the defect was coaptated to the donor nerves of the flap using the end-to-end fashion. At the last follow-up, static two-point discrimination, Semmes–Weinstein monofilament scores, pain, cold intolerance of the reconstructed finger, and patient satisfaction in both groups were compared. Results All patients were followed up for at least 17 months. No significant differences were found regarding pain of thumb pulp, static two-point discrimination, Semmes–Weinstein monofilament score, cold intolerance in the injured finger, and patient satisfaction. The non-preservation group presented slightly shorter operative times (p < 0.05). Conclusion There are no differences at 2 years in postoperative clinical outcomes when dorsal digital nerves are used to reconstruct flap sensation regardless of preservation of the dorsal branches of the proper digital nerves in the first dorsal metacarpal artery flap. Level of evidence: Level III, retrospective comparative study.

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SUPRACLAVICULAR ARTERY FLAP: A SAFE, VERSATILE AND A RELIABLE FLAP A NEW WORKHORSE IN HEAD AND NECK RECONSTRUCTION OUR CLINICAL EXPERIENCE

International Journal of Advanced Research ◽

10.21474/ijar01/12326 ◽

2021 ◽

Vol 9 (01) ◽

pp. 544-550

Author(s):

Mir Mushtaq ◽

◽

Bashir Ahmad Bhat ◽

Taj Din Wani ◽

Shabir Iqbal ◽

...

Keyword(s):

Head And Neck ◽

Donor Site ◽

Graft Loss ◽

Surgical Techniques ◽

Free Tissue Transfer ◽

Functional Results ◽

Donor Site Morbidity ◽

Head And Neck Reconstruction ◽

Wide Range

Background: Anterior cervical contractures of the neck represent a great challenge for plastic and reconstructive surgeons. Necks can be reconstructed with a wide range of surgical techniques. The supraclavicular flap is easy to harvest without the need for free tissue transfer. It provides a relatively large flap for neck resurfacing with tissue very similar to that of the neck. Material and Methods: This study was carried out in the Plastic Surgery Department of GMC Srinagar between November 2015 and October 2019. It involved 50 patients (40 females and 10 males), in whom supraclavicular artery flap was done to reconstruct head and neck. Follow-up period ranged from 2-27 months (average 12.3). Results: The study involved 50 patients. Mean age was 26.5 years (range 57-12 years). Thirty five patients had post-burn neck contractures, five patients had portwine stain face, three had marjolin ulcer, four patients had post traumatic and three had post bear maul defect. We harvested unilateral flaps in all of patients. In thirty five patients the flap was pedicled, three had adipofascial pedicle and twelve were islanded. The size of the reconstructed defect ranged from 23x10 to 14x6, and the size of the flap varied from 16x7cm to 25x11. Mean length was 21.7 cm. We used a partial thickness skin graft for donor site closure in 41 cases and closed primarily in 9 cases. Flap was used to resurface neck in 35 patients, face resurfacing in 10 patients, as intraoral lining in 3 patients. The following complications occurred: hematoma in 3 cases, partial distal necrosis in 2 cases, and donor site graft loss in 3 cases. Follow-up period ranged from 2-27 months Conclusion: The supraclavicular artery island flap is a thin, malleable fasciocutaneous flap that is easily and rapidly harvested, with a reliable pedicle and minimal donor site morbidity. It constitutes an alternative to local flaps, while providing equivalent functional results, and must be an integral part of the head and neck reconstructive surgeons therapeutic armamentarium.

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Long-term functional results of microvascular toe-to-thumb reconstruction

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193410387331 ◽

2010 ◽

Vol 36 (3) ◽

pp. 194-204 ◽

Cited By ~ 16

Author(s):

T. Kotkansalo ◽

S. Vilkki ◽

P. Elo ◽

T. Luukkaala

Keyword(s):

Recovery Of Function ◽

Hand Function ◽

Functional Results ◽

Inclusion Criteria ◽

Clinical Tests ◽

Thumb Reconstruction ◽

Initial Injury ◽

Toe Transfer

The purpose of this study was to evaluate the long-term functional results of microvascular toe-to-thumb reconstruction after trauma. Forty-one patients meeting the inclusion criteria were available for a clinical follow-up study. The function of the hand was assessed with questionnaires as well as with modified Tamai and Sollerman hand function tests. According to the questionnaires, most activities were considered easy or quite easy and the majority of the patients (36/41) managed with no or minor complaints. Clinical tests showed good recovery of function. Patient satisfaction was high. There were superficial infections in five hands and in six donor feet. In total, 16 late corrective operations were done to eight patients. Microvascular toe transfer is a good option for grip reconstruction after thumb amputation. The extent of the initial injury influences the achievable outcome, yet even a single toe transfer can restore adequate grip function.

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Donor Site Morbidity of Patients Receiving Vertical Rectus Abdominis Myocutaneous Flap for Perineal, Vaginal or Inguinal Reconstruction

World Journal of Surgery ◽

10.1007/s00268-020-05788-5 ◽

2020 ◽

Vol 45 (1) ◽

pp. 132-140

Author(s):

Vera S. Schellerer ◽

Lenka Bartholomé ◽

Melanie C. Langheinrich ◽

Robert Grützmann ◽

Raymund E. Horch ◽

...

Keyword(s):

Postoperative Complications ◽

Myocutaneous Flap ◽

Donor Site ◽

Donor Site Morbidity ◽

Rectus Abdominis ◽

Flap Reconstruction ◽

Direct Closure ◽

Vram Flap ◽

Vertical Rectus Abdominis Myocutaneous

Abstract Background Management of donor site closure after harvesting a vertical rectus abdominis myocutaneous (VRAM) flap is discussed heterogeneously in the literature. We aim to analyze the postoperative complications of the donor site depending on the closure technique. Methods During a 12-year period (2003–2015), 192 patients in our department received transpelvic VRAM flap reconstruction. Prospectively collected data were analyzed retrospectively. Results 182 patients received a VRAM flap reconstruction for malignant, 10 patients for benign disease. The median age of patients was 62 years. 117 patients (61%) received a reconstruction of donor site by Vypro® mesh, 46 patients (24%) by Vicryl® mesh, 23 patients (12%) by direct closure and 6 patients (3%) by combination of different meshes. 32 patients (17%) developed in total 34 postoperative complications at the donor site. 22 complications (11%) were treated conservatively, 12 (6%) surgically. 17 patients (9%) developed incisional hernia during follow-up, with highest incidence in the Vicryl® group (n = 8; 17%) and lowest in the Vypro® group (n = 7; 6%). Postoperative parastomal hernias were found in 30 patients (16%) including three patients with simultaneous hernia around an urostomy and a colostomy. The highest incidence of parastomal hernia was found in patients receiving primary closure of the donor site (n = 6; 26%), the lowest incidence in the Vypro® group (n = 16; 14%). Conclusion The use of Vypro® mesh for donor site closure appears to be associated with a low postoperative incidence of complications and can therefore be recommended as a preferred technique.

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Long-term effects of toe transfers on the donor feet

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413518702 ◽

2014 ◽

Vol 39 (9) ◽

pp. 966-976 ◽

Cited By ~ 8

Author(s):

T. Kotkansalo ◽

P. Elo ◽

T. Luukkaala ◽

S. K. Vilkki

Keyword(s):

Weight Bearing ◽

Donor Site ◽

Functional Testing ◽

Long Term Effects ◽

Cold Intolerance ◽

Patient Reported ◽

Functional Scores ◽

First Ray

The purpose of this study was to assess the long-term consequences to the donor site of microvascular transfer of one or two toes. This was achieved retrospectively by patient-reported, clinician-based and functional testing. Weight-bearing radiographs were taken of both feet. Seventy-four patients (80 feet, 84 transferred toes) participated in this study. After a median of 16 years follow-up, most patients reported no or only minor complaints concerning the donor site. Cold intolerance and pain during exertion were the most commonly reported complaints. According to the two functional scores used, 92% of patients reported no or minor complaint and 83% of patients received a good result at the donor feet. Maintaining first ray alignment and avoiding early postoperative complications predicted a better outcome. Even though donor site ramifications should be expected after microvascular transfer of toes, patient satisfaction remains high.

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Tongue flap- a good choice for intraoral reconstruction after marginal mandibulectomy: a single institution retrospective study of 27 cases

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20193858 ◽

2019 ◽

Vol 5 (5) ◽

pp. 1217

Author(s):

Gopu Govindhasamy ◽

Subbiah Shanmugam ◽

Rajiv Michael

Keyword(s):

Functional Outcomes ◽

Primary Tumour ◽

Donor Site ◽

Good Choice ◽

Soft Tissue Reconstruction ◽

Flap Reconstruction ◽

Tongue Flap ◽

Marginal Mandibulectomy

Background: Marginal mandibulectomy with wide excision of the primary tumour in the treatment of the oral cavity squamous cell cancers preserves the form and function of the mandible, without compromise in obtaining oncologically safe margins. Of the various methods of reconstruction of the composite intraoral tissue defect, tongue flaps offer an easy and effective method of reconstruction.Methods: We have collected the records of 27 patients who underwent marginal mandibulectomy and tongue flap reconstruction in the last 6 years from the cancer department master case sheets, operative records and follow up records. The information on the immediate and long term complications were obtained from the records and functional outcomes of patients were recorded at the time of last follow up and analysed. All the 27 patients had horizontal marginal mandibulectomy with an anteriorly or posteriorly based tongue flap reconstruction. Results: The most common early postoperative complication was infection around the flap site that occurred in 18.5% of patients. The other complications including haemorrhage, flap dehiscence occurred in few patients which were managed effectively. There was no incidence of major flap necrosis. Speech and swallowing difficulty was encountered in 18.5% and 14.8% of patients respectively. The long term complications were managed conservatively with speech and swallowing therapy.Conclusions:In our experience, tongue is an excellent donor site for intraoral soft tissue reconstruction, providing an analogous tissue for reconstruction. The technique is simple with acceptable rates of immediate and long term complications and with good functional outcomes.

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