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Zhou X, Zhang C, Fan X, Cai X, Wang X, Pan J. Transplantation of a free fillet flap from discarded fingers for repair of a finger pulp skin defect: a case report. Front Surg 2024; 11:1363827. [PMID: 38596165 PMCID: PMC11002096 DOI: 10.3389/fsurg.2024.1363827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/15/2024] [Indexed: 04/11/2024] Open
Abstract
Background Replantation represents a treatment option for patients with severed finger pulps. However, in some cases, replantation is a challenging task. Case presentation We report a successful case of finger pulp reconstruction of the ring finger using free flaps from a nonreplantable index finger in a spare-parts procedure. A 43-year-old worker accidentally injured the index, middle and ring fingers of his left hand on a machine turntable. The severed index and middle fingers and the distal pulp of the ring finger could not be replanted in situ due to extensive contusion of blood vessels and soft tissues. After vascular and nerve anastomosis, a free skin flap isolated from the nonreplantable index finger was transplanted to the wound of the distal pulpal defect of the ring finger. The flap survived completely postoperatively. Six months after the operation, only a slight deformity of the ring finger was observed. Moreover, sensation of the digit recovered well. Conclusions Spare-part surgery is a surgical approach that effectively saves and utilizes tissue that would otherwise be discarded in cases of severe limb trauma. This idea may be applied to treatment of severe injuries to multiple fingers. Additionally, in the process of tissue transplantation and repair, attention should be given to protecting the tissue in the recipient area to avoid damage to the original undamaged tissue structure, which can adversely affect healing and recovery of the tissue.
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Affiliation(s)
| | | | | | | | - Xin Wang
- Department of Plastic Reconstructive Surgery & Hand Microsurgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Jiadong Pan
- Department of Plastic Reconstructive Surgery & Hand Microsurgery, Ningbo No. 6 Hospital, Ningbo, China
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Wahyudi M, Satria O, Aprilya D, Nong I. Vertical Rectus Abdominis Myocutaneous Flap for Reconstruction of Forequarter Amputation Defect after Shoulder Soft Tissue Sarcoma Resection: Technical Consideration. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5077. [PMID: 37342308 PMCID: PMC10278745 DOI: 10.1097/gox.0000000000005077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/02/2023] [Indexed: 06/22/2023]
Abstract
Forequarter amputations in advanced local malignancy or trauma cases often leave a large defect that is challenging to reconstruct. Options for defect closure are varied. A vertical rectus abdominis myocutaneous (VRAM) flap could be an alternative to close a significantly large defect, which is relatively easier than the more technically demanding free flap. This case presents a 64-year-old man with a soft tissue sarcoma in the left shoulder that was treated by forequarter amputation and subsequent defect closure using a VRAM flap. The VRAM flap was initially used to reconstruct the chest and abdominal walls. There have been no reported uses for the shoulder defect. The repair site defect was viable even with a less aesthetic donor site, and all of the defects were closed without any signs of infection. The VRAM flap is a good option for a large defect closure at the shoulder region, particularly after forequarter amputation.
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Affiliation(s)
- Muhammad Wahyudi
- From the Orthopedic and Traumatology Department, Fatmawati General Hospital, Jakarta, Indonesia
| | - Oryza Satria
- From the Orthopedic and Traumatology Department, Fatmawati General Hospital, Jakarta, Indonesia
| | - Dina Aprilya
- From the Orthopedic and Traumatology Department, Fatmawati General Hospital, Jakarta, Indonesia
| | - Ira Nong
- Orthopedic and Traumatology Department Wahidin Sudirohusodo General Hospital, Makassar, Indonesia
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Silva JB, Becker AS, Leal BLM, Busnello CV, Furlanetto AHW, de Sousa Rebelato MR, Zawislak RB. A systematic review of the finger bank technique: what are its limits? EUROPEAN JOURNAL OF PLASTIC SURGERY 2023. [DOI: 10.1007/s00238-023-02056-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Loy E, Williamson DG, Williamson JS. Pedicled hand fillet flap to preserve stump length in below-elbow amputation. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2022; 9:110-114. [PMID: 35434200 PMCID: PMC9009952 DOI: 10.1080/23320885.2022.2054420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Spare-parts surgery in traumatic amputation sources tissue from the amputated part to cover the residual amputation defect. This case describes a trauma patient requiring below-elbow amputation. Stump closure was accomplished with a pedicled fillet flap derived from the still-attached hand, avoiding donor site morbidity and maximizing stump length.
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Affiliation(s)
- Emma Loy
- Island Medical Program, Faculty of Medicine, University of British Columbia, Victoria, Canada
| | - David G. Williamson
- Department of Surgery, Faculty of Medicine, University of British Columbia, Kelowna, Canada
| | - J. Scott Williamson
- Department of Surgery, Faculty of Medicine, University of British Columbia, Kelowna, Canada
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Optimizing surgical outcome of auricular keloid with a novel multimodal approach. Sci Rep 2022; 12:3533. [PMID: 35241718 PMCID: PMC8894473 DOI: 10.1038/s41598-022-07255-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/04/2022] [Indexed: 11/12/2022] Open
Abstract
Various treatments are available for auricular keloids, but none has an absolute advantage. A practical and safe therapy to optimize the surgical outcome for auricular keloids is needed. We adopted a multimodal treatment of surgical enucleation, core fillet flap reconstruction, intraoperative corticosteroid injection, and immediate postoperative radiotherapy. There were no routine intralesional corticosteroid injections during follow-up. Keloid recurrences, complications, and risk factors for recurrences were analyzed. The outcome was compared with other published literatures. 45 auricular keloids were included in this study. 85.7% were female with an average age of 27.1 ± 7.5 years, and averaged size was 1.8 × 1.2 ± 0.9 × 0.6 cm. 71.1% were located at ear helix with 28.9% at the ear lobe. Nine keloids were classified as Chang-Park classification type I, 30 for type II, two for type III, and four for IV. The average radiation dosage was 1578.6 cGy. The recurrence rate was 6.7% at an average 24.1-month follow-up. There were no complications of surgery, radiotherapy, and intralesional corticosteroid injection. Our recurrence rate was lower than those in mono-adjuvant therapies of intraoperative corticosteroid injection or radiotherapy. This one-session multimodal approach optimizes treating auricular keloids with a low recurrence rate and minimal post-radiation and long-term corticosteroid injection-related complications.
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Abstract
BACKGROUND Recent progress in biomechatronics and vascularized composite allotransplantation have occurred in the absence of congruent advancements in the surgical approaches generally utilized for limb amputation. Consideration of these advances, as well as of both novel and time-honored reconstructive surgical techniques, argues for a fundamental reframing of the way in which amputation procedures should be performed. METHODS We review sentinel developments in external prosthetic limb technology and limb transplantation, in addition to standard and emerging reconstructive surgical techniques relevant to limb modification, and then propose a new paradigm for limb amputation. RESULTS An approach to limb amputation based on the availability of native tissues is proposed, with the intent of maximizing limb function, limiting neuropathic pain, restoring limb perception/proprioception and mitigating limb atrophy. CONCLUSIONS We propose a reinvention of the manner in which limb amputations are performed, framed in the context of time-tested reconstructive techniques, as well as novel, state-of-the-art surgical procedures. Implementation of the proposed techniques in the acute setting has the potential to elevate advanced limb replacement strategies to a clinical solution that perhaps exceeds what is possible through traditional surgical approaches to limb salvage. We therefore argue that amputation, performed with the intent of optimizing the residuum for interaction with either a bionic or a transplanted limb, should be viewed not as a surgical failure, but as an alternative form of limb reconstruction.
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Rogozinski J, Johnson RM. Vascularized tendon graft to the central slip using a finger fillet flap. J Surg Case Rep 2020; 2020:rjaa192. [PMID: 32665832 PMCID: PMC7332288 DOI: 10.1093/jscr/rjaa192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/25/2020] [Indexed: 11/13/2022] Open
Abstract
Burn boutonniere deformity (BBD) treatment remains a challenge in reconstructive surgery. Severe hand defects after burn/trauma may be reconstructed with nonsalvageable or amputated tissue. The fillet flap (FF) is generally used as "spare parts" in the trauma algorithm for mangled extremities. This case study examines the use of a FF with concurrent repair of the adjacent finger extensor tendon with the amputated finger flexor tendon after burn injury. The goal is to provide adequate tissue coverage using a finger FF while concurrently reconstructing the central slip of the extensor tendon with the transposed flexor tendon from an adjacent nonfunctional digit. After reconstruction, no subluxation of the extensor tendon occurred with manipulation. Despite prolonged rehabilitation due to injuries, the surgical site healed appropriately. Single-stage FF reconstruction with vascularized tendon grafts should be considered in selected patients with BBD. This novel idea can be applied to the management of traumatized extremities.
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Li X, Cui J, Maharjan S, Yu X, Lu L, Gong X. Neo-digit functional reconstruction of mutilating hand injury using transplantation of multiple composite tissue flaps. Medicine (Baltimore) 2016; 95:e4179. [PMID: 27399142 PMCID: PMC5058871 DOI: 10.1097/md.0000000000004179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Functional reconstruction of mutilating hand injuries poses a challenge to the surgeon. We present our experience with use of multiple composite tissue flaps transplant for functional reconstruction of hand in patients with mutilating hand injuries. The associated merits and demerits of these surgical approaches are briefly discussed. METHODS From August 2004 to October 2014, functional reconstruction of hand with transplantation of multiple composite tissue flaps was performed in 8 patients. These included the toe with dorsal pedis artery flap, the reverse posterior interosseous artery flap, and the anterolateral thigh flap. Mean interval from injury to functional reconstruction was 10.6 days. RESULTS All transplanted skin flaps and reconstructed neofingers survived completely. Only 1 patient developed wound infection at the recipient site (hand), which resolved without any debridement or revision surgery. At the donor site (foot), partial skin necrosis was observed in 1 patient, which healed with local wound care. In other patients, all wounds healed without any complications. The average range of movement at the neofinger metacarpophalangeal and interphalangeal joints was 38° and 73°, respectively. None of the patients required revision surgery. CONCLUSION Use of negative pressure wound therapy and multiple composite tissue flap transplantation appears to be an effective strategy for hand functional reconstruction in patients with mutilating hand injuries. Among the multiple composite tissue flaps, use of toe transplantation combined with reverse posterior interosseous artery flap appears to be the best option.
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Affiliation(s)
| | | | | | | | - Laijin Lu
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin, P.R. China
- Correspondence: Laijin Lu and Xu Gong, Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China (e-mail: [LL] and [XG])
| | - Xu Gong
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin, P.R. China
- Correspondence: Laijin Lu and Xu Gong, Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China (e-mail: [LL] and [XG])
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Gachie E, Alet JM, Nguyen P, Della Volpe C, Casanova D. [Forearm osteomusculocutaneous free filet flap for arm reconstruction after amputation as an alternative to shoulder disarticulation]. ANN CHIR PLAST ESTH 2014; 60:148-52. [PMID: 25001415 DOI: 10.1016/j.anplas.2014.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/30/2014] [Indexed: 10/25/2022]
Abstract
We report the case of a 55-year-old woman suffering from a type I neurofibromatosis (also known as Von Recklinghausen neurofibromatosis) who was diagnosed with a high-grade schwannosarcoma of the median nerve, between the upper third and the medium third of the arm, upon contact with the humerus, invading the humeral vessels. The oncologic treatment of this tumour consisted in the amputation of the arm through the surgical neck of the humerus. In order to create a laterothoracic claw, to bring a partial function of the upper limb back, we decided to realize a free fillet forearm flap. This composite flap was composed of the radius and the ulna, all the forearm muscles and the skin of the anterior side of the forearm. A humeroradial plate osteosynthesis was done and the flap was then harvested with the radial pedicle, and anastomosed to the axillar artery. This procedure gave our patient a functional stump, giving back the arm functionality, especially the claw movement.
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Affiliation(s)
- E Gachie
- Service de chirurgie plastique-brûlés, Centre François-Xavier-Michelet, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
| | - J-M Alet
- Service de chirurgie plastique-brûlés, Centre François-Xavier-Michelet, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - P Nguyen
- Service de chirurgie plastique, reconstructive et esthétique, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - C Della Volpe
- Service de chirurgie plastique, reconstructive et esthétique, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - D Casanova
- Service de chirurgie plastique, reconstructive et esthétique, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
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Lin CH, Webb K, Neumeister MW. Immediate Tissue Transplantation in Upper Limb Trauma. Clin Plast Surg 2014; 41:397-406. [DOI: 10.1016/j.cps.2014.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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