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Xu H, Guo L, Wang X, Pan J. An Updated Surgical Approach of Using Flap and Cutaneous Nerve in the Lateral Arm to Reconstruct Complex Injuries of the Forearm and Hand: A Case Series Study. Ann Plast Surg 2023; 91:468-472. [PMID: 37556581 DOI: 10.1097/sap.0000000000003649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
BACKGROUND Complex injuries involving the nerves and other soft tissues in the forearm and hand lead to functional and aesthetic defects. In such situations, multiple types of nerve autografts and flap donor sites are available. However, multiple donor sites cause donor morbidity in different locations and may lead to awkward operational positions. Therefore, based on the anatomical characterization, we aimed to modify the utilization of the lateral arm donor site for reconstruction, which restricts donor morbidity in the affected upper extremity. METHODS We report a case series (N = 6) using a lateral arm flap (LAF) to reconstruct complex soft tissue defects in the forearm, palm, and finger. The posterior antebrachial cutaneous nerve (PACN) is the primary option for nerve bridging, whereas the LAF can carry the lower lateral brachial cutaneous nerve (LBCN) as a sensory flap. Once the PACN was insufficient, the LBCN was harvested simultaneously. All the cases included in this study were performed between January 2012 and August 2021. Demographic information, flap and nerve characteristics, complications, and hand function were analyzed. RESULTS The LAF plus PACN or plus LBCN as nerve autograft, both successfully repaired 6 complex injuries: 2 cases in the forearm side, 1 in the hand palm, and 3 in the finger defects. Posterior antebrachial cutaneous nerve was the most used (8-15 cm), and LBCN plus PACN was used to bridge nerve defects when necessary (in total, 20 and 21 cm). The average follow-up time was 19.7 months. The disabilities of the arm, shoulder and hand score ranged between 6 and 12, and the mean 2-point discrimination values ranged between 6 and 12. The Semmes-Weinstein monofilament test result was under 5.46. In addition, 2 patients underwent a secondary debulking surgery. The average length of hospital stay was 10.4 days. Hematoma occurred in 2 cases, and all patients reported numbness in the donor nerve innervated areas. CONCLUSIONS This surgical refinement can reconstruct complex injuries in the forearm and hand. In addition, this approach restricts donor morbidity in the affected limb, comforts the operational position, and is achieved under brachial plexus anesthesia.
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Affiliation(s)
- Heng Xu
- From the Department of Plastic Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Linxiumei Guo
- From the Department of Plastic Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Xin Wang
- Department of Hand Surgery, Ningbo Sixth Hospital, Zhejiang, China
| | - Jiadong Pan
- Department of Hand Surgery, Ningbo Sixth Hospital, Zhejiang, China
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Reconstruction of Foot and Ankle Defects Using Free Lateral Arm Flap: A Retrospective Review of Its Versatile Application. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4128827. [PMID: 34754880 PMCID: PMC8572601 DOI: 10.1155/2021/4128827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/14/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022]
Abstract
Background Successful reconstruction of the feet and ankles remains challenging due to limited quantities of soft tissue and laxity. The free lateral arm flap (LAF) is an alternative to conventional flaps and has been widely used due to advancements in its flap characteristics. This study is aimed at utilizing the advantages of this flap to validate its increased applications for foot and ankle defects. Methods Twenty patients with various LAF types between May 2011 and May 2020 were enrolled. Clinical data was retrospectively collected, and defect sites were classified according to the subunit principle. We utilized various LAF types, such as LAFs with sensate, extended, osteomyocutaneous, or myocutaneous flaps, as necessary. A two-point discrimination test was performed, and results were statistically compared between flaps. Results Among the diverse etiologies of skin defects, chronic inflammation was the most common cause of defects. Various LAF types, including LAFs with fasciocutaneous, extended fasciocutaneous, musculocutaneous, and osteomyocutaneous flaps, were used. The versatility of free LAF helped successfully cover various defects in all cases. Results of the two-point discrimination test were statistically significant between groups. Conclusions Free LAF is a unique soft tissue free flap that is more versatile than other flaps, allowing flaps to be continuously modified and applied to various foot and ankle defects under different clinical conditions.
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Zhang Y, Gazyakan E, Hundeshagen G, Fischer S, Bigdeli AK, Marks PW, Kneser U, Hirche C. A meta-analysis evaluating risk factors for compound free flaps for upper extremity defect reconstruction comparing complications and functional outcomes of compound free flaps with and without bone components. Microsurgery 2021; 41:688-696. [PMID: 34357657 DOI: 10.1002/micr.30791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 07/06/2021] [Accepted: 07/22/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Compound flaps offer the advantage of one stage defect reconstruction respecting all relevant tissues and early functional recovery by optimal vascularity of all components. Due to its specific vascular anatomy and the three-dimensional donor site, compound flaps with bone components may result in higher complication rates compared to soft tissue compound flaps. The meta-analysis summarizes the available evidence and evaluates whether bone components are a risk factor for periprocedural complications in upper extremity multidimensional defect reconstruction. METHOD PubMed and Embase were searched for all publications addressing compound free flaps for upper extremity defect reconstruction with bone or soft tissue components published between January 1988 and May 2018. The methodological quality was assessed with the American Society of Plastic Surgeons Evidence Rating Scale for Therapeutic Studies. Flap loss, thrombosis rate, early infection, hematoma, seroma, as well as donor site complications were extracted and analyzed. RESULTS Twelve out of 1157 potentially eligible studies (evidence-III) comprising 159 patients were finally included with publication bias for all summarized complication rates. Complication rates for flaps with/ without bone components were: total flap loss 5%, 95% CI = 3%-10% (6%/5%); partial flap loss 8%, 95% CI = 5%-15%, (9%/8%); arterial/venous thrombosis 7%, 95% CI = 4%-12%, (8%/5%)/14%, 95% CI = 9%-21% (16%/6%, P < .05) with higher risk for flaps with bone components; infection 6%, 95% CI = 3%-12% (6%/6%); hematoma 6%, 95% CI = 3%-11% (6%/5%); seroma 5%, 95% CI = 3%-10% (5%/5%); dehiscence 10%, 95% CI = 6%-17% (11%/9%). CONCLUSION Compound flaps for upper extremity defect reconstruction including bone components have a higher venous thrombosis rate compared to compound soft-tissue flaps.
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Affiliation(s)
- Ying Zhang
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany.,Department of Burn, Plastic and Reconstructive Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Emre Gazyakan
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany
| | - Gabriel Hundeshagen
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany
| | - Sebastian Fischer
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany
| | - Amir K Bigdeli
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany.,Department of Plastic, Hand and Reconstructive Microsurgery, Hand-Trauma and Replantation Center, BG Unfallklinik Frankfurt am Main gGmbH, Affiliated Hospital to the Goethe-University Frankfurt am Main, Germany
| | - Patrick Will Marks
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany
| | - Christoph Hirche
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany.,Department of Plastic, Hand and Reconstructive Microsurgery, Hand-Trauma and Replantation Center, BG Unfallklinik Frankfurt am Main gGmbH, Affiliated Hospital to the Goethe-University Frankfurt am Main, Germany
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Walton RL, Harris EA. The First Dorsal Metacarpal Artery Free Flap for Salvage of Nasal Reconstructions. Ann Plast Surg 2021; 86:302-307. [PMID: 32842030 DOI: 10.1097/sap.0000000000002510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The first dorsal metacarpal artery free flap is widely known for its use as a pedicled flap in thumb and hand reconstruction; however, its potential for use as a free flap is less well known. We previously described successful use of the first dorsal metacarpal artery free flap for salvage of a subtotal nasal reconstruction. In this retrospective study, we have expanded our experience to 7 consecutive cases in which a FDMFF was utilized to salvage a nasal reconstruction. Single island flaps were used in 6 of 7 cases, in one case a double island configuration was utilized. Sites restored included the columella (5 patients), membranous septum (1 patient), and nasal sidewall (1 patient). Vascular repairs were to the angular artery and vein (2 patients) or the vascular pedicle of a prior free flap (5 patients). There were no flap failures or major complications. The dorsal hand donor sites were uniformly closed using full-thickness skin grafts. All of the salvage nasal reconstructions were brought to a successful completion. Donor site morbidity was minimal with no compromise in hand function noted. Owing to its thinness, consistent anatomy, ease of harvest, and minimal donor site morbidity, the FDMFF has proved to be a very useful flap for restoration of small, but critical, nasal defects arising during the course of nasal reconstruction.
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Affiliation(s)
| | - Emily A Harris
- Department of Surgery, Amita Saint Joseph Hospital Chicago, Chicago, IL
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Ullah S, Asif M, Ubaid M, Khalid A, Khan M, Rahman MF. Lateral Arm Flap: Its Usage as Pedicle and Free Flap. Cureus 2020; 12:e12136. [PMID: 33489548 PMCID: PMC7811680 DOI: 10.7759/cureus.12136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The lateral arm flap is an excellent flap for both local and microvascular reconstruction. For local reconstruction on the upper extremity or as a distant microvascular flap, its advantages include short operation time, thin pliable tissue, non-dominant vessel, and minimal donor site morbidity. Moreover, it fulfills the goal of optimal reconstruction of form, function, and aesthetics. The objective is to share our experience of using the lateral arm flap, both as a free flap and as a pedicled flap. Methods After taking exemption from the ethical review committee (ERC) of Aga Khan University Hospital, a retrospective data analysis of patients who had undergone lateral arm flap at the Plastic and Reconstructive Surgery department of the Aga Khan University Hospital was carried out from January 2012 to December 2019. The data examined included the patient's age, gender, diagnosis, location of the defect, size of the flap, and outcome of the flap at three weeks post-operation. For free flaps, data of the recipient artery used for anastomosis and the number of veins anastomosed were also included. Results Over a period of eight years, 33 lateral arm flaps were performed, including 23 free flaps and 10 pedicled flaps. The average size of the free flap was 12x6 cm and that of the pedicled flap was 8x5 cm. In the free-flap group, there was a failure in three flaps, two of which were due to arterial anastomosis in the zone of injury. There were no failures in the pedicled flap group. Conclusion The lateral arm flap is a reliable flap, with consistent anatomy, which can be used for coverage in different parts of the body.
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Affiliation(s)
- Sami Ullah
- Plastic and Reconstructive Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad Asif
- Plastic Surgery, Cancer Foundation Hospital, Karachi, PAK.,Community Health Sciences, Aga Khan University, Karachi, PAK
| | - Muhammad Ubaid
- Plastic and Reconstructive Surgery, Aga Khan University Hospital, Karachi, PAK
| | - Amna Khalid
- Plastic and Reconstructive Surgery, Aga Khan University Hospital, Karachi, PAK
| | - Majid Khan
- Plastic and Reconstructive Surgery, Aga Khan University Hospital, Karachi, PAK
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Yu F, Tang J, Pan D. Reconstruction of the dorsum of the hand and fingers with a bifoliate lateral arm flap: a case report. J Hand Surg Eur Vol 2020; 45:765-766. [PMID: 32362192 DOI: 10.1177/1753193420920812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Fang Yu
- Xiangya Hospital, Central South University, Changsha, China
| | - Juyu Tang
- Xiangya Hospital, Central South University, Changsha, China
| | - Ding Pan
- Xiangya Hospital, Central South University, Changsha, China
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Verifying the Versatility and Reliability of Free Lateral Arm Flap for Head and Neck Reconstruction. J Craniofac Surg 2020; 31:e688-e693. [PMID: 32804818 DOI: 10.1097/scs.0000000000006586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The lateral arm flap is an alternative to the conventional radial forearm flap and has been widely used due to advancements in flap characteristics. Especially, the fasciocutaneous flap has been widely used in head and neck reconstruction due to its versatile characteristics and surgical feasibility. This flap has successfully undergone several useful modifications based on various anatomical studies. Here, the authors aimed to verify the versatility and reliability of free lateral arm flap reconstruction of numerous head and neck defects. Twelve patients (6 men and 6 women; mean age, 66 years) with various types of lateral arm flaps from May 2017 to April 2019 were included. The anatomical reconstruction area was widely distributed across the facial subunits, tongue and oral cavity, and hypopharynx, among others. The flap varied in size from 3 × 5 cm to 17 × 7 cm, and the average pedicle length was 5.58 cm. The versatility of the lateral arm flap enabled successful coverage of various defects in all cases. Among 12 patients, the donor site outcome was rated as excellent and good by 2 and 10 patients, respectively. Three patients complained of post-operative hypoesthesia, which was subsequently resolved. The lateral arm flap is a unique and extremely versatile soft tissue free flap. Its versatility facilitates continuous modification of the flap and its application in various areas in different forms with excellent contour outcomes. The authors successfully verified the evolving methods and advantages of lateral arm flaps in the treatment of various head and neck defects.
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Zhang Y, Gazyakan E, Bigdeli AK, Will‐Marks P, Kneser U, Hirche C. Soft tissue free flap for reconstruction of upper extremities: A meta‐analysis on outcome and safety. Microsurgery 2019; 39:463-475. [DOI: 10.1002/micr.30460] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 03/29/2019] [Accepted: 04/05/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Ying Zhang
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn CenterBG Trauma Center, Department of Plastic and Hand Surgery, University of Heidelberg Ludwigshafen Germany
| | - Emre Gazyakan
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn CenterBG Trauma Center, Department of Plastic and Hand Surgery, University of Heidelberg Ludwigshafen Germany
| | - Amir K. Bigdeli
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn CenterBG Trauma Center, Department of Plastic and Hand Surgery, University of Heidelberg Ludwigshafen Germany
| | - Patrick Will‐Marks
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn CenterBG Trauma Center, Department of Plastic and Hand Surgery, University of Heidelberg Ludwigshafen Germany
| | - Ulrich Kneser
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn CenterBG Trauma Center, Department of Plastic and Hand Surgery, University of Heidelberg Ludwigshafen Germany
| | - Christoph Hirche
- Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn CenterBG Trauma Center, Department of Plastic and Hand Surgery, University of Heidelberg Ludwigshafen Germany
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Lateral arm flap: indications and techniques. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:279-284. [PMID: 30649619 DOI: 10.1007/s00590-019-02363-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
The lateral arm flap (LAF) is a popular flap transfer, which can be applied in many procedures. It was first described in 1982, and till then, even more clinical applications are suggested. It can be used as a free fasciocutaneous or fascial flap to cover small- to medium-sized soft tissue defects in head and neck but also in upper and lower extremity reconstruction, or as an osteocutaneous flap when vascularized bone graft is needed. We present the indications and contraindications, the advantages and disadvantages, as well as the step-by-step technique of harvesting a fasciocutaneous and an osteocutaneous flap and its complications. We conclude that the LAF is a reliable and versatile tool for reconstructive surgery, due to its anatomical characteristics and the low complication rate.
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Ye SM, Yu Y, Jing JH, Zhou Y, Zhang JS, Teng XF, Xu CG, Cheng WD, Li ZY, Xu YJ. One-stage reconstruction of complex soft tissue defects in the hands using multidigit, chimeric, lateral arm, perforator flaps. J Plast Reconstr Aesthet Surg 2018; 72:902-908. [PMID: 30630749 DOI: 10.1016/j.bjps.2018.12.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 09/21/2018] [Accepted: 12/02/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe our experience using microsurgically fabricated, multilobed, chimeric, lateral arm (LA) flaps to reconstruct hand injuries with complex, multidigit, soft tissue defects and to evaluate the morbidity and esthetic and functional outcomes of the donor sites. METHODS We performed a single center, retrospective analysis of 21 patients with hand wounds treated from October 2013 to February 2016. All patients underwent reconstruction using multilobed, chimeric, free, LA flaps. A self-reported questionnaire was used to assess donor site morbidity and satisfaction with the esthetic and overall functional result. Outcome measures were the Disabilities of the Arm, Shoulder and Hand (DASH) score, static 2-point discrimination score, and visual analogue scale. RESULTS The study included 21 patients (20 males and 1 female), with an average age of 32.14 years (range 18-45 years), who sustained traumatic injuries in road traffic accidents (n = 2) or industrial devices (n = 19). The average DASH score was 28.25 ± 2.3, the average 2-PD score was 7.20 ± 1.30, and the average visual analogue scale (VAS) was 0.38 ± 0.40. All 21 patients had sensory disorders at the donor site. Postoperative donor site complications comprised wound dehiscence (n = 1) and hematoma (n = 3). The patient-rated satisfaction score for the donor site was 5.40 ± 0.90, and 70% of the patients would undergo the same surgery again. CONCLUSION Microsurgical fabrication of multilobed, chimeric, LA flaps can exhibit sensory recovery and minimal pain but may cause hematoma and sensory disorders at the donor site. The flaps are a viable alternative for the reconstruction of complex, multidigit, soft tissue defects of the hands.
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Affiliation(s)
- Shu-Ming Ye
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Soochow University, SuZhou, 235131, Jiangsu, China; Department of Orthopaedics Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Yue Yu
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Jue-Hua Jing
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Yun Zhou
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Ji-Sen Zhang
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Xiao-Feng Teng
- Department of Orthopaedics Surgery, the Sixth Hospital of Ningbo, Ningbo, 315000, Zhejiang, China
| | - Chun-Gui Xu
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Wen-Dan Cheng
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Zi-Yu Li
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - You-Jia Xu
- Department of Orthopaedics Surgery, the Second Affiliated Hospital of Soochow University, SuZhou, 235131, Jiangsu, China.
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Vitse J, Bekara F, Bertheuil N, Sinna R, Chaput B, Herlin C. Perforator-based propeller flaps reliability in upper extremity soft tissue reconstruction: a systematic review. J Hand Surg Eur Vol 2017; 42:157-164. [PMID: 27671797 DOI: 10.1177/1753193416669262] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Current data on upper extremity propeller flaps are poor and do not allow the assessment of the safety of this technique. A systematic literature review was conducted searching PubMed, EMBASE, and the Cochrane Library electronic databases, and the selection process was adapted from the preferred reporting items for systematic reviews and meta-analysis statement. The final analysis included ten relevant articles involving 117 flaps. The majority of flaps were used for the hand, distal wrist, and elbow. The radial artery perforator and ulnar artery perforator were the most frequently used flaps. The were 7% flaps with venous congestion and 3% with complete necrosis. No difference in complications rate was found for different flaps sites. Perforator-based propeller flaps appear to be an interesting procedure for covering soft tissue defects involving the upper extremities, even for large defects, but the procedure requires experience and close monitoring. LEVEL OF EVIDENCE II.
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Affiliation(s)
- J Vitse
- 1 Departments of Plastic and Reconstructive Surgery, Burns and Wound Healing Units, CHRU Lapeyronie, Montpellier, France
| | - F Bekara
- 1 Departments of Plastic and Reconstructive Surgery, Burns and Wound Healing Units, CHRU Lapeyronie, Montpellier, France
| | - N Bertheuil
- 2 Department of Plastic, Reconstructive and Aesthetic Surgery, CHRU Rennes, Rennes, France
| | - R Sinna
- 3 Department of Plastic, Reconstructive and Aesthetic Surgery, CHRU Picardie, Amiens, France
| | - B Chaput
- 4 Department of Plastic, Reconstructive and Aesthetic Surgery, CHRU Rangeuil, Toulouse, France
| | - C Herlin
- 1 Departments of Plastic and Reconstructive Surgery, Burns and Wound Healing Units, CHRU Lapeyronie, Montpellier, France
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Al-Kandari Q, Kalandar A, Burezq H. Versatility of lateral arm flap for hand reconstruction—a clinical experience. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-016-1211-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Nagpal P, Maller V, Garg G, Hedgire S, Khandelwal A, Kalva S, Steigner ML, Saboo SS. Upper Extremity Runoff: Pearls and Pitfalls in Computed Tomography Angiography and Magnetic Resonance Angiography. Curr Probl Diagn Radiol 2016; 46:115-129. [PMID: 26949062 DOI: 10.1067/j.cpradiol.2016.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 01/25/2016] [Indexed: 12/13/2022]
Abstract
Upper extremity vasculature can be affected by various traumatic and nontraumatic pathologies; however, the evaluation of these arteries can be challenging for the radiologists as well as for the clinicians. After an accurate history and clinical examination, imaging plays a vital role in the diagnosis and treatment planning of these patients. Depending on the urgency and the indication, upper extremity arteries may be evaluated by ultrasonography with color Doppler, computed tomography (CT), magnetic resonance imaging (MRI), or digital subtraction angiography. This review article discusses relevant imaging anatomy of the upper extremity arteries, presents CT and MRI protocols, briefly describes the state-of-the-art CT and MRI of various pathologies affecting the upper extremity arteries, and summarizes the important pearls needed for busy practicing radiologist.
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Affiliation(s)
- Prashant Nagpal
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA; Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
| | - Vinod Maller
- Division of Interventional Radiology, Department of Radiology, University of Tennessee Health Science Center, Memphis, TN
| | - Gunjan Garg
- Department of Nuclear Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Yeshiva University, New York, NY
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ashish Khandelwal
- Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Sanjeeva Kalva
- Division of Interventional Radiology, Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Michael L Steigner
- Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Sachin S Saboo
- Division of Cardiothoracic Imaging, Department of Radiology, UT Southwestern Medical Center, Dallas, TX
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Song D, Li J, Li K, Liu J, Xu J. Modified Innervated Radial Collateral Artery Perforator Flap for Repairing Digital Defects. Indian J Surg 2015; 77:1032-7. [DOI: 10.1007/s12262-014-1117-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 05/26/2014] [Indexed: 11/24/2022] Open
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Gu JX, Regmi S, Zhang NC, Liu HJ, Zhang WZ, Xu T. Second toe microsurgical free-flap for aesthetic and sensory reconstruction of palmar soft tissue defects of fingers. J Plast Reconstr Aesthet Surg 2015; 69:323-7. [PMID: 26546110 DOI: 10.1016/j.bjps.2015.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 06/08/2015] [Accepted: 10/13/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To illustrate the surgical methods and clinical efficacy of microsurgical free-flaps obtained from second toe for the reconstruction of palmar soft-tissue defect of fingers. METHODS We enrolled 22 patients (13 men and 9 women), who received second toe free-flap for 22 finger defects between August 2007 and July 2013. The average age was 35 years (range, 18-62 years). The average size of flap was 2.7 cm × 2.0 cm (range, 1.5 cm × 1.5 cm-3.5 cm × 2.5 cm). RESULTS All flaps survived well without any complications. Follow-up period ranged from 8 to 30 months (mean 15 months). The Visual Analog Scale for flap appearance (VAS flap) was ranged from 8 to 10 (average, 9.5). Based on the CISS questionnaires, 6 cases had mild cold intolerance. The average value of Michigan Hand Outcome Questionnaire (MHOQ) scoring for overall hand function was 8 (range, 5-13). The sensibility outcomes in 10 patients who underwent nerve repair were satisfactory. Average value of static two point discrimination (2PD) was 6.4 mm (range, 4-10 mm) and SWM test was 3.45 (range 2.83-4.12). CONCLUSIONS Second toe free micro-flap is a very useful and reliable alternative for the reconstruction of palmer soft-tissue defect of fingers. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jia-xiang Gu
- Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou City, Jiangsu Province, 225001, PR China.
| | - Subhash Regmi
- College of Medicine, Yangzhou University, 11th Huaihai Road, Yangzhou City, Jiangsu Province, 225009, PR China
| | - Nai-chen Zhang
- Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou City, Jiangsu Province, 225001, PR China
| | - Hong-jun Liu
- Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou City, Jiangsu Province, 225001, PR China
| | - Wen-zhong Zhang
- Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou City, Jiangsu Province, 225001, PR China
| | - Tao Xu
- Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou City, Jiangsu Province, 225001, PR China
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Wong VW, Katz RD, Higgins JP. Interpretation of upper extremity arteriography: vascular anatomy and pathology [corrected]. Hand Clin 2015; 31:121-34. [PMID: 25455362 DOI: 10.1016/j.hcl.2014.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Understanding the utility and interpretation of upper extremity angiography is critical for the hand surgeon treating vaso-occlusive diseases of the hand. Although invasive and requiring the use of contrast dye, it remains the gold standard for imaging of the vascular system of the upper extremity. Angiography may detect numerous variants of the upper limb arterial system which may contribute to surgical pathology. Extensive vascular collateralization helps to maintain perfusion to the hand and facilitates reconstruction of the upper extremity. It is paramount to remember that angiography is a dynamic study and should represent a "flexible roadmap" for surgical reconstruction.
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Affiliation(s)
- Victor W Wong
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA
| | - Ryan D Katz
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA
| | - James P Higgins
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA.
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17
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Abstract
Adequate soft-tissue coverage of the hand is paramount to achieve optimal aesthetic and functional results in patients with complex hand defects. In this article, the authors present four illustrative clinical cases and discuss potential reconstructive modalities. For each scenario, two surgical options are discussed: one established and one nontraditional method of reconstruction. The authors' preferred method and technical pearls for execution are presented.
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