Free multilobed posterior interosseous artery perforator flap for multi-finger skin defect reconstruction

Background: The soft tissues of the radial aspect of the hand are predominantly affected in firecracker and homemade bomb blast injuries. In such cases, regional flap options are quite appealing for defect coverage. We have compared the outcomes of using two pedicled regional forearm flaps in these injuries, the posterior interosseous artery flap (PIAF) and the adipofascial radial artery perforator flap (ARAPF).Methods: 37 patients underwent reconstruction of the hand with PIAF (20 cases) and ARAPF (17 cases) between January 2014 and December 2019. They were compared with regards to patient demographics, reconstruction techniques, short-term and long-term functional and aesthetic outcomes using the disabilities of the arm, shoulder and hand (DASH) score and the subjective satisfaction score (SSS).Results: All our flaps survived without any major complications affecting long-term outcome. We found no statistically significant difference between the two flaps in terms of patient demographics, flap paddle size, duration of hospital stay, DASH score and SSS for recipient site. However, significant difference was noted in the duration of surgery, method of donor site closure and SSS for the donor site.Conclusions: Both the PIAF and ARAPF can be considered in cases of soft tissue defects of the hand from firecracker or bomb blast injuries. Both preserve the major arteries of the hand while still having reliable vascular pedicle.

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Free superficial circumflex iliac artery perforator flap with a single-pedicle bilobed design for pediatric multi-digit defect reconstruction

10.21203/rs.2.23810/v2 ◽

2020 ◽

Author(s):

Zhangcan Li ◽

Dawei Zheng ◽

Jian Zheng ◽

Weiya Qi ◽

Qiang Qi ◽

...

Keyword(s):

Iliac Artery ◽

Pediatric Patients ◽

Color Doppler ◽

Perforator Flap ◽

Interphalangeal Joint ◽

Soft Tissue Reconstruction ◽

Tactile Sense ◽

Defect Reconstruction ◽

Artery Perforator

Abstract Objectives: This paper describes imaging and anatomical features, in order to assess the feasibility of superficial circumflex iliac artery perforator (SCIP) flap with a single-pedicle bilobed design for multi-digit skin and soft tissue reconstruction in pediatric patients.Methods: A total of 7 pediatric patients who were being treated with free single-pedicle bilobed SCIP flap reconstruction for multi-digit defects were included in this study. The details of the clinical features were collected, and the following were successively analyzed: the preoperative Computed Tomographic Angiography (CTA) and Color Doppler Sonography (CDS) examinations for flap design, the intraoperative anatomy for perforator vessel, defect reconstruction and interphalangeal range of motion (ROM) and tactile sense, pain sense and two-point discrimination recovery results.Results: CTA and CDS performed preoperatively could accurately and rapidly identify the position, location and course of the SCIP flap. All wounds healed by the first follow-up and no complications occurred at the follow-up visit. All flaps survived, the patients achieved proximal interphalangeal joint (PIP) ranges of motions (ROM) from 80 to 100 degree and distal interphalangeal joint (DIP) ROM from 65 to 80 degree. The tactile sense and pain sense recovered, and average of the two-point discrimination scores was 9.3mm (range 7-12mm). The donor area was primarily sutured with good scar concealment in the underwear region.Conclusion: CTA and CDS performed preoperatively are accurate and intuitive methods for assessing the location and course of SCIP. The SCIP flap is highly suitable for pediatric patients due to its small caliber, specific functional and aesthetic benefits. It can be designed in a lobulated fashion in order to repair two or more wounds during one surgery. We suggest that the free single-pedicle bilobed SCIP flap should be considered an optimal choice for multi-digit defect reconstruction in pediatric patients in the clinic.

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Dorsal Metacarpal Artery Perforator Flap for Skin Ulcer Due to a Postoperative Complication of Suture Anchor Treatment for Tendinous Mallet Finger

Plastic Surgery Case Studies ◽

10.1177/2513826x20957128 ◽

2020 ◽

Vol 6 ◽

pp. 2513826X2095712

Author(s):

Koichi Yano ◽

Yasunori Kaneshiro ◽

Ryo Sasaki ◽

Seungho Hyun ◽

Hideki Sakanaka

Keyword(s):

Suture Anchor ◽

Perforator Flap ◽

Skin Ulcer ◽

Ulcer Formation ◽

Skin Defect ◽

Mallet Finger ◽

Initial Surgery ◽

Finger Injury ◽

Dorsal Metacarpal Artery ◽

Artery Perforator

The suture anchor method of surgery has some complications. To best of our knowledge, no report on skin ulcer formation apart from the surgical site after tendinous mallet finger injury using suture anchor is available. We present the case of a 73-year-old woman who sustained tendinous mallet finger in an accident. She was treated surgically with a suture anchor. At 12 months after surgery, the string from the surgical site was removed; 28 months after surgery, a skin ulcer was formed 2-cm proximal from the operative scar, and discharge leaked from the dorsal middle phalanx. Because the wound could not heal by conservative treatment, it was treated surgically. At initial surgery, debridement of the skin ulcer, including the suture knot, was performed. At second surgery, the skin defect was reconstructed using a third dorsal metacarpal artery perforator flap. At 1 year postoperatively, she had no symptoms without recurrence.

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