Reconstruction of Large Palmar Defects of the Hand Using Free Flaps

The reconstruction of large palmar defects of the hand remains a difficult problem due to the specific anatomical structures and highly sophisticated function of the palm. The glabrous skin and subcutaneous tissue in the palm are perfectly adapted to serve the prehensile function. The particular aim must be that repairs to this functional structure are similar in texture and colour and are aesthetically acceptable. Restoration of sensibility is desirable. For smaller defects a great variety of local pedicled or island flaps can be applied. However, for larger defects with exposed tendons, nerves or other essential structures, free flaps remain as a reliable alternative. This paper reviews our approach of soft tissue reconstruction in 16 patients with large palmar defects using various kinds of free flaps. The advantages, disadvantages and current indications for free flap resurfacing of the palm are discussed.

Download Full-text

Achilles Region Soft-Tissue Defects: A Reconstructive Algorithm Based on a Series of 46 Cases

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1606554 ◽

2017 ◽

Vol 33 (S 01) ◽

pp. S40-S47 ◽

Cited By ~ 2

Author(s):

Marco Innocenti ◽

Serena Ghezzi ◽

Luca Delcroix ◽

Alessandro Innocenti

Keyword(s):

Soft Tissue ◽

Free Flap ◽

Single Case ◽

Weight Bearing ◽

Free Flaps ◽

Full Weight Bearing ◽

Medium Size ◽

Soft Tissue Reconstruction ◽

Tissue Reconstruction ◽

Reconstructive Algorithm

Background Several options have been described for soft-tissue reconstruction in Achilles tendon region (ATR). The best procedure should be customized according to any single case taking into account the number of structures involved, the quality of the neighboring skin, and patient's general condition. The aim of this article is to describe a simplified reconstructive algorithm based on personal experience and reviewing literature. Methods Forty-four patients, who underwent ATR soft-tissue reconstruction between 1998 and 2016, have been retrospectively reviewed. Etiologies of the defect include the following: 18 posttraumatic, 10 postoncologic, 14 dehiscence/infection, and 2 chronic ulcers. Follow-up ranges between 12 and 96 months. Free flaps have been used in 30 cases (including two secondary surgeries due to propeller flap failure) and propeller flaps have been used in 16 cases. Results Thirty-six flaps survived uneventfully (78.3%). Total flap necrosis occurred in three cases (6.5%), namely, two propeller flaps and one free flap. Partial necrosis of the flap was observed in seven cases (15, 2%): three in the free flap group and four in the propeller group. The functional recovery was very good in all the patients without involvement of the tendon and also all the patients who underwent a simultaneous reconstruction of the tendon with different techniques recovered a full weight bearing and a satisfactory range of motion. Conclusion Propeller flaps are a valuable option for skin reconstruction in case of defects of small and medium size not involving the tendon. In case of larger defects and when a simultaneous ATR reconstruction is required, a free flap seems to be a better option.

Download Full-text

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

Plastic & Reconstructive Surgery Global Open ◽

10.1097/gox.0000000000002543 ◽

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

Download Full-text

Timing of Soft Tissue Reconstruction

Standards for the Management of Open Fractures ◽

10.1093/med/9780198849360.003.0007 ◽

2020 ◽

pp. 57-62

Keyword(s):

Soft Tissue ◽

Internal Fixation ◽

Free Flap ◽

Soft Tissue Reconstruction ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Fracture Union ◽

Patient Factors ◽

Tissue Reconstruction ◽

Wound Excision

Soft tissue cover of a meticulously and comprehensively excised (debrided) wound is the cornerstone of achieving infection-free fracture union. Planning of the soft tissue reconstruction should ideally occur at the time of wound excision. Definitive soft tissue reconstruction should be performed within 72 hours of the injury unless precluded by patient factors, and at the same time as internal fixation of the fracture. Free flap reconstruction is ideally performed on scheduled lists in specialist orthoplastic centres.

Download Full-text

Feasibility of virtual surgical simulation in the head and neck region for soft tissue reconstruction using free flap: a comparison of preoperative and postoperative volume measurement

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2020.07.025 ◽

2020 ◽

Author(s):

S. Yokoi ◽

N. Nishio ◽

Y. Fujimoto ◽

M. Fujii ◽

K. Iwami ◽

...

Keyword(s):

Soft Tissue ◽

Head And Neck ◽

Free Flap ◽

Surgical Simulation ◽

Neck Region ◽

Volume Measurement ◽

Soft Tissue Reconstruction ◽

Head And Neck Region ◽

Tissue Reconstruction

Download Full-text

Topical Application of Fasudil Hydrochloride for Vasospasm during Soft Tissue Reconstruction Using a Free Flap

Case Reports in Orthopedics ◽

10.1155/2019/5929281 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Kaoru Tada ◽

Tadahiro Nakajima ◽

Mika Nakada ◽

Masashi Matsuta ◽

Hiroyuki Tsuchiya

Keyword(s):

Blood Flow ◽

Soft Tissue ◽

Topical Application ◽

Free Flap ◽

Arterial Blood Flow ◽

Soft Tissue Reconstruction ◽

Clinical Report ◽

Arterial Blood ◽

Malignant Soft Tissue Tumor ◽

Tissue Reconstruction

Vasospasm is a phenomenon that can complicate microsurgery. We report a case in which vasospasm was quickly relieved by topical application of fasudil hydrochloride. A 36-year-old man underwent preoperative chemotherapy and wide excision for a malignant soft tissue tumor around the knee joint. We planned reconstruction using a free latissimus dorsi muscle flap for the resulting soft tissue defect and selected the peroneal vessels as the recipient vessels. However, there was no arterial blood flow from the peroneal vessels, which we diagnosed as vasospasm. Conventional treatment of the vasospasm was attempted, but blood flow was not achieved. Topical application of fasudil hydrochloride solution promptly relieved the vasospasm. To the best of our knowledge, this is the first clinical report of the use of fasudil hydrochloride for vasospasm during soft tissue reconstruction using a free flap.

Download Full-text