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Boretto JG, Holc F, Victorica PB. The Foot as a Donor Site for Reconstruction in the Hand. Hand Clin 2024; 40:249-258. [PMID: 38553096 DOI: 10.1016/j.hcl.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The foot contains a unique collection of tissue types that can be used in the reconstruction of the hand. Numerous reconstructive options have been presented, some of which have been adopted, such as modifications to procedures that have been described in the past or even newly developed options for hand reconstruction. It is possible to reconstruct missing fingers and other hand structures using tissues taken from the foot rather than removing healthy tissue from a hand that has already been injured. This makes it possible to avoid having healthy tissue removed from an injured hand.
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Affiliation(s)
- Jorge G Boretto
- Hand and Upper Extremity Surgery Department, Prof. Dr. "Carlos Ottolenghi Institute", Hospital Italiano de Buenos Aires.
| | - Fernando Holc
- Hand and Upper Extremity Surgery Department, Prof. Dr. "Carlos Ottolenghi Institute", Hospital Italiano de Buenos Aires
| | - Pedro Bronenberg Victorica
- Hand and Upper Extremity Surgery Department, Prof. Dr. "Carlos Ottolenghi Institute", Hospital Italiano de Buenos Aires
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Evaluation of Primary and Secondary Free Flap Desyndactylization Techniques in Hand and Digit Reconstruction: A Systematic Review. JOURNAL OF RECONSTRUCTIVE MICROSURGERY OPEN 2020. [DOI: 10.1055/s-0040-1721705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractObjective Injuries of the hand often require free flap reconstruction. To minimize flap loss, evidence exists to surgically syndactylize digits when repairing multiple injuries, with delayed flap division, or desyndactylization. However, evidence suggests that division of the flap at the time of inset can be accomplished with minimal negative effect. The purpose of this study was to evaluate outcomes, following hand reconstruction with free flaps utilizing either acute or staged desyndactylization techniques.Methods A systematic review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Articles that described the use of a free flap for surgically syndactylized digits or multilobed flaps for coverage of multiple digits were included.Results One hundred sixty-one articles were reviewed with 34 fulfilling inclusion criteria. One hundred seventeen patients underwent 145 free flap reconstructions. Traumatic avulsions (49%) were the most common injuries, followed by burns (11%). Twenty-one (62%) papers described surgical syndactylization of digits, which were later desyndactylized and five (15%) papers included reconstruction of more than one digit with multilobed free flaps. Eight papers (24%) described both techniques. Overall, 100% of included flaps survived. Total complication rate was 6%, with six complications (67%) occurring in flaps with primary syndactylization.Conclusion Hand defects often require free flaps for reconstruction. Although free flaps for the reconstruction of digital defects is technically demanding, they result in better outcomes. With available evidence indicating complications rates less than those of staged desyndactylization, multidigit reconstruction with multilobed free flaps may be a more desirable technique.
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Tang L, Pafitanis G, Yang P, Li Z, Jia M, Koshima I, Song D, Chi Z. Combined multi-lobed flaps: A series of 39 extensive hand and multi-digit injuries one-staged reconstructions using modified designs of ALT, DPA and chimeric linking flaps. Injury 2017; 48:1527-1535. [PMID: 28392073 DOI: 10.1016/j.injury.2017.03.049] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/26/2017] [Accepted: 03/30/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The use of multiple small flaps linked in a "chain-linked" flap microanastomosed chimeric system is recommended in distal hand and digital defects reconstruction. The aim of this study is to demonstrates our experience utilizing microsurgical fabrication, multi-lobed and linking combined flaps for the reconstruction of hand degloving injuries with complex multidigit soft tissue defects. METHODS Microanastomosed chimeric flap systems using ALT and DPA modified designed flaps were combined in five selections to cover extensive soft tissue defects involving the hands and multiple digits of 39 patients (M:F - 36:3) from October 2009 to February 2013. Five different microsurgical combined chimeric flap systems utilised in extensive hand and multidigit injuries; innervated ALT flaps, multilobed DPA flaps, innervated ALT flap with multilobed DPA flap, innervated ALT flap with sensate ALT flap and bilobed ALT flap with multilobed DPA flap. All DPA donor sites were reconstructed using free ALT flap and anterior tibial artery propeller flap. RESULTS Thirty-nine combined free flap extremities reconstructions on 39 patients (M:F - 36:3) with average age 28.5 (18-45) years sustained traumatic degloving injuries, 24 from road traffic accidents and 15 from industrial devices. Five different designs of combined multi-lobed flaps have be successfully used without any peri-operative complications. Average follow-up of 12 months, all flaps survived without complications. Operated extremities showed favorable functional recovery with restoration of the diminished protective sensation on the flap through reinnervation. All flaps survived uneventfully with coverage matching the texture and color of the recipients. Donor sites healed without complication. CONCLUSION The microsurgical fabrication of chimeric ALT flaps and multilobed DPA flaps is a valuable alternative for the reconstruction of hand degloving injury with complex multidigit soft tissue defects. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Liang Tang
- Department of Repair and Reconstructive Surgery, Department of Plastic Surgery, Hangzhou First People's Hospital and The Affiliated Hospital of Nanjing Medical School, Nanjing University, Hangzhou, Zhejiang 310000, China
| | - Georgios Pafitanis
- Academic Plastic Surgery Unit, Queen Mary University of London, London, United Kingdom
| | - Peng Yang
- Department of Orthopedic Trauma Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Zan Li
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Ming Jia
- Department of Repair and Reconstructive Surgery, Department of Plastic Surgery, Hangzhou First People's Hospital and The Affiliated Hospital of Nanjing Medical School, Nanjing University, Hangzhou, Zhejiang 310000, China
| | - Isao Koshima
- Department of Plastic and Reconstructive Surgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1138655, Japan
| | - Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China.
| | - Zhenglin Chi
- Department of Orthopedic Surgery (Division of Plastic and Hand Surgery), The Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, China.
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Song B, Chen J, Han Y, Hu Y, Su Y, Li Y, Zhang J, Guo S. The use of fabricated chimeric flap for reconstruction of extensive foot defects. Microsurgery 2015; 36:303-9. [PMID: 25752811 DOI: 10.1002/micr.22399] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 01/07/2015] [Accepted: 02/17/2015] [Indexed: 11/08/2022]
Abstract
Repair of extensive foot defects requires both adequate tissues for wound coverage and special tissues for functional reconstruction. To maximize its function reconstruction, fabricated chimeric flaps consisting of multiple separate flaps were designed to reconstruct such defects. Five patients suffered extensive foot defects with sizes ranging from 23 × 12 cm to 38 × 14 cm(2) in multiple regions including heel, forefoot, dorsum, ankle, anterior leg, and even toes. Causes included crushing injuries, avulsion injuries, and scar excision. Most areas of the defects except heel were first covered by latissimus dorsi muscle flap or anterolateral thigh flap and their pedicles were anastomosed with recipient vessels. Then free medial plantar flaps were transferred for heel reconstruction and their pedicles were further attached to either side branches of the main source vessel or to its distal continuation. All chimeric flaps survived uneventfully and all patients were able to walk in normal footwear during the 1.5- to 4-years follow-up. None of the flaps developed ulcer and flap breakdown. The assessment by Maryland Foot Score showed that four of the five patients gained a "good" recovery and one patient showed moderate improvement of foot functions. Appearances of reconstructed heels were near-normal. The results indicate that fabricated chimeric flap has good design flexibility and may provide an option for functional reconstruction of extensive foot defects. © 2015 Wiley Periodicals, Inc. Microsurgery 36:303-309, 2016.
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Affiliation(s)
- Baoqiang Song
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jianwu Chen
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yan Han
- Department of Plastic Surgery, 301 Military Hospital of China, Beijing, China
| | - Yalan Hu
- Department of Plastic Surgery, 260th Hospital of PLA, Shijiazhuang, China
| | - Yingjun Su
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yang Li
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Juan Zhang
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shuzhong Guo
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
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Acar MA, Güzel Y, Güleç A, Türkmen F, Erkoçak ÖF, Yılmaz G. Reconstruction of multiple fingertip injuries with reverse flow homodigital flap. Injury 2014; 45:1569-73. [PMID: 25037528 DOI: 10.1016/j.injury.2014.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 06/02/2014] [Accepted: 06/08/2014] [Indexed: 02/02/2023]
Abstract
AIM Hand trauma may lead to multiple fingertip defects, causing functional restrictions. We evaluated the use of reverse-flow homodigital flap reconstruction of the distal phalanx and pulp defects associated with multiple finger injuries. METHODS We retrospectively evaluated 11 male patients who presented at our emergency department (January 2011-March 2013) with multiple fingertip injuries and who were treated with a reverse-flow homodigital flap. Evaluations included age, sex, defect size, flap survival rate, complications, cold intolerance, two-point discrimination, range of motion (ROM), quick disabilities of the arm, shoulder, and hand (DASH) score, and return to work time. RESULTS Completely, 22 reverse-flow homodigital flaps were applied to at least two fingertip injuries at the distal phalanx. Ten flaps survived postoperatively. The exception was partial flap loss on one finger. The mean follow-up was 14.2 months. At the final follow-up, the mean static two-point discrimination value was 10.3mm. Mean ROMs of interphalangeal joints were 65.31° (distal) and 105.77° (proximal). Donor sites were covered with full-thickness skin grafts from the wrist or antecubital area. There were no complications related to the donor site and no development of cold intolerance in any finger. The mean quick DASH score was 4.12. All patients returned to work in an average of 8.3 weeks. CONCLUSIONS The reconstruction of multiple fingertip injuries with reverse-flow homodigital flaps is a safe, effective method that can be combined with other local finger flaps. These flaps can be applied to two consecutive fingers without reducing finger length or function.
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Affiliation(s)
- Mehmet A Acar
- Selçuk University, Selçuk School of Medicine, Department of Orthopaedics and Traumatology, Campus of Alaeddin Keykubat, Selçuklu 42075, Konya, Turkey
| | - Yunus Güzel
- Ordu University, School of Medicine, Department of Orthopaedics and Traumatology, Campus of Cumhuriyet, Ordu 52200, Turkey.
| | - Ali Güleç
- Selçuk University, Selçuk School of Medicine, Department of Orthopaedics and Traumatology, Campus of Alaeddin Keykubat, Selçuklu 42075, Konya, Turkey
| | - Faik Türkmen
- Necmettin Erbakan University, Meram School of Medicine, Department of Orthopaedics and Traumatology, Campus of Meram, Meram 42080, Konya, Turkey
| | - Ömer F Erkoçak
- Selçuk University, Selçuk School of Medicine, Department of Orthopaedics and Traumatology, Campus of Alaeddin Keykubat, Selçuklu 42075, Konya, Turkey
| | - Güney Yılmaz
- Selçuk University, Selçuk School of Medicine, Department of Orthopaedics and Traumatology, Campus of Alaeddin Keykubat, Selçuklu 42075, Konya, Turkey
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