scholarly journals Clinical study of dorsal ulnar artery flap in hand reconstruction

2009 ◽  
Vol 42 (01) ◽  
pp. 052-057
Author(s):  
Manal M. Khan ◽  
Mohd. Yaseen ◽  
L. M. Bariar ◽  
Sheeraz M. Khan
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Ulnar Artery ◽  
Donor Site Morbidity ◽  
Island Flap ◽  
Split Thickness Skin Graft ◽  
Soft Tissue Defects ◽  
Dorsal Branch ◽  
Web Space ◽  
Tissue Defects

ABSTRACTSoft tissue defects of hand with exposed tendons, joints, nerves and bone represent a challenge to plastic surgeons. Such defects necessitate early flap coverage to protect underlying vital structures, preserve hand functions and to allow for early rehabilitation. Becker and Gilbert described flap based on the dorsal branch of the ulnar artery for defects around the wrist. We evaluated the use of a dorsal ulnar artery island flap in patients with soft tissue defects of hand. Twelve patients of soft tissue defects of hand underwent dorsal ulnar artery island flap between August 2006 and May 2008. In 10 male and 2 female patients this flap was used to reconstruct defects of the palm, dorsum of hand and first web space. Ten flaps survived completely. Marginal necrosis occurred in two flaps. In one patient suturing was required after debridement and in other patient wound healed by secondary intention. The final outcome was satisfactory. Donor areas which were skin grafted, healed with acceptable cosmetic results. The dorsal ulnar artery island flap is convenient, reliable, and easy to manage and is a single-stage technique for reconstructing soft tissue defects of the palm, dorsum of hand and first web space. Donor site morbidity is minimal, either closed primarily or covered with split thickness skin graft.

Preliminary Experience with Perforator Flaps in Reconstruction of Soft-Tissue Defects of the Foot and Ankle

2005 ◽  
Vol 26 (3) ◽  
pp. 191-197 ◽  
Author(s):  
Frederick J. Duffy ◽  
James W. Brodsky ◽  
Christian T. Royer
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
Soft Tissue Reconstruction ◽  
Foot And Ankle ◽  
Soft Tissue Defects ◽  
Perforator Flaps ◽  
Microsurgical Reconstruction ◽  
Tissue Defects

Background: Microsurgical reconstruction has improved limb salvage in patients who because of many etiologies have soft-tissue loss from the lower extremities. Free-tissue transfer to the foot and ankle often interferes with postoperative function and footwear because of the bulk of a muscle flap. The foot and ankle often are best treated using thin flaps that will not contract and fibrose, particularly if secondary procedures are required. We hypothesized that perforator flaps, which are thin free-tissue transfers consisting of skin and subcutaneous tissue, both diminish donor site morbidity and are ideally suited for soft-tissue reconstruction of the foot and ankle. Methods: Ten patients had free- tissue transfers to the foot and ankle using perforator flaps during a 2-year period. Four had acute posttraumatic wounds, three had soft tissue defects with exposed hardware or bone graft after reconstructive surgery, and three had large soft-tissue defects after foot infection secondary to diabetes. Nine had reconstruction with anterolateral thigh perforator flaps and one had reconstruction with a deep inferior epigastric artery (DIEP) perforator flap. Results: All flaps survived. There were no deep infections. Three flaps had minor tissue loss requiring subsequent small skin grafts, all of which healed. There were no donor site complications and no interference of muscle function at the donor sites. Custom shoewear was not required to accommodate the flaps. Conclusion: This series highlights the success and utility of perforator flaps in microsurgical reconstruction of the foot and ankle. The greatest advantage of perforator flaps is the diminished donor site morbidity, which was achieved while maintaining high microsurgical success rates. These skin and fat flaps remained pliable and contracted less than muscle flaps, allowing for smooth tendon gliding and easy flap elevation for secondary orthopaedic procedures.

The Dorsal Flap of the First Web

2003 ◽  
Vol 28 (2) ◽  
pp. 121-124 ◽  
Author(s):  
A. PAGLIEI ◽  
L. ROCCHI ◽  
A. TULLI
Keyword(s):  
Soft Tissue ◽  
Index Finger ◽  
Tissue Loss ◽  
Space Region ◽  
Soft Tissue Defects ◽  
Dorsal Branch ◽  
Web Space ◽  
Distally Based ◽  
Soft Tissue Loss ◽  
Tissue Defects

In the first web space region, there are communications between the dorsal arteries which arise from the dorsal branch of the radial artery and the digital arteries of the thumb and the index finger. These allow a distally based flap to be raised in the first dorsal intermetacarpal area. This flap has been used in 15 cases of soft-tissue loss from the thumb and index finger. The donor sites were closed primarily in all but two patients. There were no complications, and the results show that this flap is useful for soft-tissue defects on the tip and the palmar and dorsal surfaces of the thumb. Moreover, it may be used as a “cross-finger” flap.

scholarly journals Reconstruction of a soft tissue defect of the thumb using a modified dorsal metacarpal artery flap: A case report study

2021 ◽  
Vol 3 (2) ◽  
pp. 107-112
Author(s):  
Christos Konstantinidis ◽  
Christos Kotsias ◽  
Dimitrios Giotis ◽  
Vasileios Panagiotopoulos ◽  
Konstantinos Konidaris ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Skin Graft ◽  
Donor Site ◽  
Perforator Flap ◽  
Skin Incision ◽  
Split Thickness Skin Graft ◽  
Skin Defect ◽  
Soft Tissue Defects ◽  
Dorsal Metacarpal Artery ◽  
Tissue Defects

Finger injuries to the hand with extensive soft tissue defects might be challenging to treat. Typically, the first dorsal metacarpal artery (DMA) flap is used for reconstruction, whereas closure of the donor site is routinely performed with a split-thickness skin graft. The aim of the current study is to present a surgical technique that reports a modified incision, which allows elevation of the first DMA flap for the management of the soft tissue defects of the thumb without requiring a skin graft for coverage of the donor site. A 65-year-old man presented to the emergency department with a crush injury to the thumb. The patient had an extensive skin defect on the dorsal side of the thumb extending circumferentially to the ipsilateral thenar without tendon damages, whereas sensation of the finger was found intact. Surgical intervention was performed within six hours and involved DMA flap transfer through a modified skin incision, which allowed coverage of the donor defect in the index finger with a second DMA perforator flap. 3 months postoperatively, patient’s satisfaction, sensation and range of motion (ROM) of the fingers were assessed using The Michigan Hand Outcomes Questionnaire (MHQ) and the 2-point discrimination (2-PD) test. The patient regained active ROM of the thumb and index along with complete preservation of sensation, while the final cosmetic outcome was satisfactory. The application of this technique allows coverage of both trauma defect and donor site with a single skin incision, providing a successful clinical outcome.

scholarly journals Microsurgery Technique in the Foot Reconstruction of Soft Tissue Defects: A Review of 4 Cases

1970 ◽  
Vol 1 (1) ◽  
Author(s):  
Parintosa Atmodiwirjo ◽  
Afriyanti Sandhi
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Free Tissue Transfer ◽  
Donor Site Morbidity ◽  
Soft Tissue Defects ◽  
Tissue Transfer ◽  
Anterolateral Thigh ◽  
Radial Forearm ◽  
Foot Reconstruction ◽  
Tissue Defects

The restoration of an intact covering is the primary surgical requisite following soft tissue defects in the foot because deep healing can be no better than the surface covering. Soft tissue defects that expose underlying bones, joints, and tendons pose challenging problems and require a free tissue transfer for a successful reconstruction.Total of 4 flaps in the foot was performed between February 2009 to February 2010. We reconstructed soft tissue defects in the foot in 4 patients using 3 free anterolateral thigh (ALT) flaps and 1 free radial forearm (RF) flap. Trauma was the commonest cause in our patients.Free ALT and RF flaps provided stable and durable long-term wound cover in all patients. Complications were few and manageable.Free tissue transfer has become commonplace 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 experience, we found that the using of free ALT and RF flaps in foot defects reconstruction, to be technically affordable, reliable and have resulted in excellent outcomes.

scholarly journals Inferiorly based thigh flap for reconstruction of defects around the knee joint

2014 ◽  
Vol 47 (02) ◽  
pp. 221-226 ◽  
Author(s):  
Md. Sohaib Akhtar ◽  
Arshad Hafeez Khan ◽  
Mohammed Fahud Khurram ◽  
Imran Ahmad
Keyword(s):  
Soft Tissue ◽  
Knee Joint ◽  
Donor Site ◽  
Wound Dehiscence ◽  
Donor Site Morbidity ◽  
Fasciocutaneous Flap ◽  
Venous Congestion ◽  
Soft Tissue Defects ◽  
Recipient Site ◽  
Tissue Defects

ABSTRACT Background: Soft-tissue defects around the knees are common in injured limbs and in the same injury the leg is often involved and the thigh is spared. Furthermore due to pliable and relatively lax skin, we have used inferiorly based thigh flap to reconstruct defects around knee joint. Aims and Objectives: The aim of this study is to evaluate the use of inferiorly based thigh flap to cover soft-tissue defects over the proximal one-third of the leg, patellar region, knee, and lower thigh. Materials and Methods: This study was conducted during the period between October 2011 and February 2013. Inferiorly based anteromedial thigh fasciocutaneous flap was performed on 12 patients and inferiorly based anterolateral thigh fasciocutaneous flap on four patients. The sites of the soft-tissue defects included patellar regions, infrapatellar region, upper one-third of leg, lower thigh, and over the knee joint. Results: Patients were evaluated post-operatively in terms of viability of flap, the matching of the flap with the recipient site, and donor site morbidity. All the flaps survived well except one which developed distal marginal flap loss, one in which wound dehiscence was noticed, and two in which mild venous congestion was observed. Venous congestion in two patients subsided on its own within 3 days. One patient with wound dehiscence achieved complete healing by secondary intention. Patient who developed distal flap loss required debridement and skin grafting. No appreciable donor site morbidity was encountered. Skin colour and texture of the flap matched well with the recipient site. Conclusions: The inferiorly based thigh flap is a reliable flap to cover the defect over proximal one-third of the leg, patellar region, knee, and lower thigh.

scholarly journals REVERSE RADIAL FOREARM FLAP

2018 ◽  
Vol 25 (12) ◽  
Author(s):  
Hyder Ali ◽  
Bushra Zulfiqar
Keyword(s):  
Soft Tissue ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Donor Site ◽  
Skin Grafting ◽  
Mechanical Trauma ◽  
Soft Tissue Defects ◽  
Radial Forearm ◽  
Web Space ◽  
Tissue Defects

Objectives: To highlight the usefulness of reverse radial forearm fasciocutaneous flap in covering various soft tissue defects of hand and wrist. Study Design: Descriptive, experimental study. Setting: Department of Plastic & Reconstructive Surgery, Dow University of Health Sciences & Dr Ruth KM Pfau Civil Hospital Karachi. Period: December 2016 to January 2018. Material & Methods: A total of 16 reverse radial forearm flaps were utilizedto cover various soft tissue defects of hand and wrist from various etiologies including road traffic accidents, mechanical trauma, and industrial trauma and fireworks injuries were included. Patients with segmental bone loss and those patients having partial of complete amputation of thumb were excluded. The age ranged from 18 – 45 (mean 29.25) years. Soft tissue defects of dorsum were covered with this flap in 8 cases, 4 cases on palmer aspect and 2 cases for transmetacarpal level and 1st web space defects each. Donor site was covered with split skin graft in all cases. Patients were followed for at least three months postoperatively. Results: We had partial loss of flap in two cases which was managed with debridement and skin grafting. Superficial epidermolysis was found in one case and managed conservatively. Donor site was skin grafted in all cases which was healed uneventfully and quite acceptable to the patients in due course of time. Conclusion: Reverse radial artery flap has a quite long arc of rotation, which brings it great ease to cover the soft tissue defects of various areas of hand like palm, dorsum and first web space.

scholarly journals Use of Perforator Propeller Flaps for Coverage of Soft issue Defects Around The Distal Leg and Ankle

2021 ◽  
Vol 39 (2) ◽  
pp. 87-93
Author(s):  
Avijit Sarker ◽  
Kazi Nishat Ara Begum ◽  
Sajedur Reza Faruquee ◽  
Md Ayub Ali ◽  
Maruf Alam Chowdhury ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Soft Tissue Defect ◽  
Peroneal Artery ◽  
Medial Malleolus ◽  
Soft Tissue Defects ◽  
Flap Loss ◽  
Orthopedic Rehabilitation ◽  
Tissue Defects

Introduction: Perforator propeller flap is a suitable option to cover soft tissue defects in the distal leg and ankle which preserves the main vascular arteries of the lower extremity and muscle function. The aim of this study is to evaluate the use of perforator propeller flaps for coverage of soft tissue defects around the distal leg and ankle. Methods: This prospective study was donebetween December 2018 to November 2019in the Department of Burn & Plastic Surgery of National Institute of Traumatology and Orthopedic Rehabilitation ( NITOR), Dhaka. Total 32 patients with small to medium sized soft tissue defect over distal leg and ankle underwent reconstruction with perforator propeller flaps. Sixteen patients had defect over tendo achilles area, 6 had defect over lateral malleolus,7 over medial malleolus and medial aspect of distal third leg and only 3 had defect in front of ankle. Average Flap length and width were 12.72 (+4.19) & 5.63 (+1.78) cm respectively. Flap rotation was measured 180 degrees in 84.37% of the cases. The propeller flaps were based on a single perforator and it was observed from the posterior tibial artery in 62.5% and peroneal artery in 37.5% of the cases. Results: 81.25% of the flaps completely survived. Total flap loss was observed in one case (3%) while partial flap loss occurred in 6.2% cases. Marginal flap necrosis and epidermolysis were observed in 6.2% and 3% cases respectively. Conclusions: Propeller flapshavereliable vascular pedicle as well as greater freedom in design and arc of rotation that extend the possibility ofreconstructing difficult wounds with local tissues and minimal donor-site morbidity. J Bangladesh Coll Phys Surg 2021; 39(2): 87-93

scholarly journals Soft tissue reconstruction of low voltage electric burn injuries of the thumb and first web space by the first dorsal metacarpal artery island flap: a three-year study from Eastern India

2020 ◽  
Vol 7 (4) ◽  
pp. 1082
Author(s):  
Madhumita Gupta ◽  
Prabir Kumar Jash
Keyword(s):  
Soft Tissue ◽  
Low Voltage ◽  
Burn Injuries ◽  
Soft Tissue Defects ◽  
Dorsal Metacarpal Artery ◽  
Web Space ◽  
Electric Burns ◽  
Tissue Defects ◽  
First Dorsal Metacarpal Artery

Background: Complex soft tissue defects of thumb and first web space are a reconstructive challenge. Low voltage electric burns of the hand commonly result in localised and deep soft tissue destruction. The first dorsal metacarpal artery flap (FDMA) is an attractive local flap option to reconstruct these. This study illustrates our experience with the same.Methods: Between March 2014 and February 2017, 16 patients with complex soft tissue defects of thumb and first web space resulting from low voltage electric burns underwent reconstruction with the FDMA flap and subsequent structured hand therapy. In the follow up visits objective assessment of hand function included tests of mobility using Kapandji Score, sensory evaluation with static 2 point discrimination and cortical reorientation. The Subjective Satisfaction Score was used to ascertain the patient’s overall perception of aesthetic and functional outcome.Results: Majority (43.75%) of the patients had defects involving the thumb IP joint. No case of complete flap failure was noted. In a mean follow-up of 11.5 months the reconstructed thumb showed return of good protective sensation as well as mobility. Though cortical reorientation was complete in only 18.75 %, it did not substantially impede hand functioning. All patients were satisfied with the functional and aesthetic result.Conclusions: In cases of low voltage electric burn injuries the FDMA flap is a reliable reconstructive option for small to moderate sized complex defects of thumb and first web space. It has minimal donor site morbidity and can be accomplished in a relatively simple single stage procedure.

A Comparative Study of the Reverse Sural Fascio-Cutaneous Flap Outcomes in the Management of Foot and Ankle Soft Tissue Defects in Diabetic and Trauma Patients

2018 ◽  
Vol 12 (5) ◽  
pp. 432-438 ◽  
Author(s):  
Chahine Assi ◽  
Camille Samaha ◽  
Moussa Chamoun Moussa ◽  
Tony Hayek ◽  
Kaissar Yammine
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Low Frequency ◽  
Group Versus ◽  
Healing Time ◽  
Diabetic Patients ◽  
Trauma Patients ◽  
Soft Tissue Defects ◽  
Cutaneous Flap ◽  
Tissue Defects

Introduction. Soft tissue defects in the distal leg and foot are challenging conditions for reconstruction. The widely used reverse sural fascio-cutaneous flap (RSFCF) has been reported with large variation in complication frequency. Some authors reported higher complications in the diabetic population when compared with trauma patients. We compared the reliability of the RSFCF in treating such defects among both populations. Methods. This is a retrospective series with a prospective data collection of 24 patients (11 with type 2 diabetes and 13 in trauma settings) treated with an ipsilateral RSFCF for soft tissue defects of the distal leg and the rear foot. Healing events and complications were recorded and compared for both groups. The mean follow-up was 32 months. Results. Diabetic group versus trauma group showed the following results; mean flap healing time of 24 versus 22 days, donor site healing time of 14 versus 16 days, 1 total flap necrosis in both groups, 3 versus 2 cases of skin edge necrosis, 2 cases of temporary venous congestion in both groups, and 8 versus 10 cases of transient hypoesthesia of the lateral border of the foot. No infection was encountered in both groups and no recurrence of infection in the primary infected diabetic patients. Conclusions. We found the RSFCF to be useful, reproducible, and reliable in treating soft tissue defects with a very low frequency of serious complications. Diabetic patients were found to have similar outcomes when compared with trauma patients. Therefore, diabetes might not be a major factor of flap failure. Levels of Evidence: Level III: Therapeutic

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