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Soldado F, Rojas-Neira J, Rivas-Nicolls D, de Oliveira RK, Shen XF. Anatomical study of first palmar intermetacarpal flap in cadavers and application for congenital first web contracture in a child with Apert's syndrome. Microsurgery 2024; 44:e31134. [PMID: 37953638 DOI: 10.1002/micr.31134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/09/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Reconstructing severe first web contractures often involves using either pedicled forearm flaps, which can cause extensive scarring, or free flaps, which can be highly complex. In this study, we present a local palmar hand flap that overcomes both of these challenges. METHODS Ten fresh upper limbs were examined after arterial injection with colored latex. The study focused on identifying the most distal palmar vascular cutaneous branches suitable for designing an elliptical cutaneous flap over the volar intermetacarpal area. This flap's width was approximately 50% of the width of the thenar eminence. Additionally, we present the case of an 8-year-old child with a type 1 Upton's Apert's hand, which exhibited a severe first web contracture. RESULTS In seven cadaver hands, one distal cutaneous perforator was found, while in three hands, two perforators were identified. These perforators originated from the thumb radial collateral artery six times, pollex princeps three times, index radial collateral vessels twice, and thumb ulnar collateral vessels twice. The mean perforator diameter was 0.5 mm (ranging from 0.4 to 0.6 mm), and the mean perforator length was 10 mm (ranging from 0.8 to 12 mm). Using this flap bilaterally in our patient resulted in a straightforward procedure that created a broad and functional first web. A total-thickness skin graft was necessary to cover the proximal thenar area, and fortunately, no complications arose. A wide first web with an intermetacarpal angle of 40° ultimately was obtained scoring 8 on the kapandji. CONCLUSIONS The first palmar intermetacarpal flap presents itself as a reasonable and uncomplicated option for addressing significant moderate-to-severe first web contractures.
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Affiliation(s)
- Francisco Soldado
- Pediatric Hand Surgery and Microsurgery, Barcelona Children's Hospital, HM Nens, HM Hospitales, Barcelona, Spain
| | - Juliana Rojas-Neira
- Hand Surgery and Microsurgery Department, Farallones Clinic, Christus Health, Cali, Colombia
- Pontificia Javeriana University, Cali, Colombia
| | - Danilo Rivas-Nicolls
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Xiao F Shen
- Department of Hand Surgery, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
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Cutaneous Perforators and Their Clinical Implications on Intrinsic Hand Flaps: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4154. [PMID: 35475281 PMCID: PMC9029897 DOI: 10.1097/gox.0000000000004154] [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: 12/15/2021] [Accepted: 01/04/2022] [Indexed: 11/09/2022]
Abstract
Background: Most hand flaps are local intrinsic flaps because hand perforators are small and fragile. The purpose of this review was to gather anatomical data on cutaneous perforators of the hand and their implications on intrinsic hand flaps. Methods: An electronic search was performed through PubMed, Scopus, ScienceDirect, ProQuest, and CINAHL in April 2021. The search terms included “hand,” “palm,” “manus,” “cutaneous artery,” “angiosome,” and “perforasome.” Studies were filtered according to the PRISMA flow chart, and critically appraised using the Quality Appraisal for Cadaveric Studies (QUAC) and Appraisal Tool for Cross-sectional Studies (AXIS). Results: A total of 33 studies were included, of which 20 were pure anatomical studies, 10 combined anatomical and clinical studies, and three imaging-based clinical studies. A total of 643 hands and 406 fingers were included. The dorsal aspect of the hand, the dorsal digits, hypothenar, midpalm, thenar, and dorsal wrist consistently have adequate, closely distributed perforators of small diameters and short pedicle lengths. A series of clinical studies proved the success of elevating local perforator flaps on each of these areas. Conclusions: The hand contained densely interlinked cutaneous perforators of varying sizes and pedicle lengths. Although some areas of the hand are still unexplored, knowledge on cutaneous perforators of the hand allows the creation of a variety of possibilities for intrinsic hand flap designs.
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Reverse Superficial Palmar branch of Radial artery pedicled flap for Palmar and Digital reconstruction: A systematic review of literature with a retrospective case review. JPRAS Open 2021; 29:144-156. [PMID: 34195334 PMCID: PMC8237525 DOI: 10.1016/j.jpra.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/05/2021] [Indexed: 12/04/2022] Open
Abstract
Background Most studies on the superficial palmar branch of radial artery (SUPBRA) flap involve its use as a free flap with only few reports in literature regarding its use as a reverse pedicled flap. This systematic review presents a summary of the available literature on the indications, anatomy, technique, complications and outcomes of the reverse SUPBRA flap and also describes our experience. Methods A computer search was performed on the Embase, Medline and Pubmed databases for clinical studies describing the reverse SUPBRA flap in accordance with the standard principles for systematic review and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A retrospective review of cases performed by the senior author was also conducted. Results Seven studies qualified for the review with 50 flaps in 50 patients meeting the inclusion criteria. The senior author has performed nine reverse SUPBRA flaps from 2006 to 2015. The flap was found to be most useful for defects of the thumb, index, palm and first webspace. Variations in vascular anatomy may necessitate a change of operative strategy. Venous congestion was common but transient in the majority. Complications were rare and included minor tip necrosis, scar contracture, donor site sensitivity and numbness, thumb adduction contracture and cold intolerance. Conclusions The reverse SUPBRA flap is a versatile flap for reconstructing defects of the thumb, index, palm and first webspace. It is quick to raise, has a low donor site morbidity and complication rate and achieves very reasonable functional and aesthetic outcomes.
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Mabvuure NT, Pinto-Lopes R, Iwuagwu FC, Sierakowski A. A systematic review of outcomes following hand reconstruction using flaps from the superficial palmar branch of the radial artery (SUPBRA) system. J Plast Reconstr Aesthet Surg 2020; 74:79-93. [PMID: 33067122 DOI: 10.1016/j.bjps.2020.08.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Flaps based on the superficial branch of the radial artery (SUPBRA) are indicated when homo- or heterodigital flaps are inappropriate, but glabrous or like-for-like reconstruction is required. AIM To systematically review the outcomes of hand reconstruction using SUPBRA flaps. METHODS PubMed was searched for English-language articles studying SUPBRA flaps in November 2019. Data collected included flap vascular supply, dimensions, complications, donor site closure, and two-point discrimination. RESULTS Twenty-six papers were eligible (410 flaps). Flaps were classified as glabrous, nonglabrous or combined. Nonglabrous flaps were either free- (52%) or reverse-flow pedicled (1.7%) wrist flaps. Glabrous flaps were either free palmar (36.3%), reverse-flow pedicled palmar (2%), antegrade-flow pedicled palmar (0.2%) or perforator-based island palmar flaps (3.7%). Combined glabrous/nonglabrous flaps formed 4.1% of flaps. Maximal flap dimensions allowing direct closure were: 3.1 × 6 cm for wrist flaps and <3 × 10 cm for glabrous palmar flaps. Combined flaps can be 10 × 16 cm. Overall, complete and partial flap failure rates were 3.17% and 0.98%, respectively. Most complete failures were due to venous thrombosis. All 220 wrist donor sites were closed directly. Two out of 173 palmar donor sites (≥3.1) could not be primarily closed. Wound complications were rare, but 53.4% of free palmar flaps required debulking. The results of neurorrhaphy were inconsistent. CONCLUSIONS Flaps based on the SUPBRA are robust, provide like-for-like reconstruction of glabrous skin defects in one-stage, offer versatility due to diverse skin paddle orientation patterns and are in the same operative field as the defect.
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Affiliation(s)
- N T Mabvuure
- St Andrews Centre for Plastic Surgery, Broomfield Hospital, Court Road, Chelmsford CM1 7ET, United Kingdom.
| | - R Pinto-Lopes
- St Andrews Centre for Plastic Surgery, Broomfield Hospital, Court Road, Chelmsford CM1 7ET, United Kingdom
| | - F C Iwuagwu
- St Andrews Centre for Plastic Surgery, Broomfield Hospital, Court Road, Chelmsford CM1 7ET, United Kingdom
| | - A Sierakowski
- St Andrews Centre for Plastic Surgery, Broomfield Hospital, Court Road, Chelmsford CM1 7ET, United Kingdom
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Goffinet L, Dantzer E. Coverage of soft tissue defects in acute surgery for deep burns of the limbs. ANN CHIR PLAST ESTH 2020; 65:345-379. [PMID: 32928577 DOI: 10.1016/j.anplas.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
Burns of the limbs affect 48.6% of burn patients. Injury mechanisms condition their depth and degree of extension. Injury of the hands and/or the joint areas entails considerable risk of retraction. Coverage is consequently doubly challenging, it is a matter not only of compensating for a soft tissue defects, but also of striving to prevent early (infectious) and late (amplitude limitation, pain, loss of function…) complications. Thoroughgoing assessment of the initial injury and associated lesions is conducive to rapid determination of a therapeutic strategy tailored to the relevant functional issues and subsequent rehabilitation. Following a summary of the epidemiological elements and the medical context of management, a review of existing treatments has been drawn up based on the data in the literature and current professional recommendations. Emergency procedures, the different types of excision and the possibilities of autologous covering and skin substitutes are reported. Last but not least, routinely validated indications are synthesized.
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Affiliation(s)
- L Goffinet
- Service de chirurgie infantile orthopédique/pediatric orthpedic surgery unit, hôpital d'enfant/children's hospital, université de Lorraine/university of Lorraine, CHRU de Nancy, 11, rue du Morvan, 54510 Vandœuvre-lès-Nancy, France.
| | - E Dantzer
- Centre des brûlés/burn treatment, hôpital d'instruction des armées Sainte-Anne/Sainte-Anne armed forces teaching hospital, boulevard Sainte-Anne, BP 20545, 83041 Toulon, France.
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Tsunekawa K, Nagai F, Kato T, Takashimizu I, Yanagisawa D, Yuzuriha S. Hallucal thenar index: A new index to detect peripheral arterial disease using laser speckle flowgraphy. Vascular 2020; 29:100-107. [PMID: 32638660 DOI: 10.1177/1708538120938935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Laser speckle flowgraphy is a technology using reflected scattered light for visualization of blood distribution, which can be used to measure relative velocity of blood flow easily without contact with the skin within a short time. It was hypothesized that laser speckle flowgraphy may be able to identify foot ischemia. This study was performed to determine whether laser speckle flowgraphy could distinguish between subjects with and without peripheral arterial disease. MATERIALS AND METHODS All subjects were classified based on clinical observations using the Rutherford classification: non-peripheral arterial disease, class 0; peripheral arterial disease group, class 2-5. Rutherford class 6 was one of the exclusion criteria. Laser speckle flowgraphy measured the beat strength of skin perfusion as an indicator of average dynamic cutaneous blood flow change synchronized with the heartbeat. The beat strength of skin perfusion indicates the strength of the heartbeat on the skin, and the heartbeat strength calculator in laser speckle flowgraphy uses the blood flow data to perform a Fourier transform to convert the temporal changes in blood flow to a power spectrum. A total of 33 subjects with peripheral arterial disease and 40 subjects without peripheral arterial disease at a single center were prospectively examined. Laser speckle flowgraphy was used to measure hallucal and thenar cutaneous blood flow, and the measurements were repeated three times. The hallucal and thenar index was defined as the ratio of beat strength of skin perfusion value on hallux/beat strength of skin perfusion value on ipsilateral thenar eminence. The Mann-Whitney U-test was used to compare the median values of hallucal and thenar index and ankle brachial index between the two groups. A receiver operating characteristic curve for hallucal and thenar index of beat strength of skin perfusion was plotted, and a cutoff point was set. The correlation between hallucal and thenar index of beat strength of skin perfusion and ankle brachial index was explored in all subjects, the hemodialysis group, and the non-hemodialysis (non-hemodialysis) group. RESULTS The median value of the hallucal and thenar index of beat strength of skin perfusion was significantly different between subjects with and without peripheral arterial disease (0.27 vs. 0.87, respectively; P < 0.001). The median value of ankle brachial index was significantly different between subjects with and without peripheral arterial disease (0.8 vs. 1.1, respectively; P < 0.001). Based on the receiver operating characteristic of hallucal and thenar index, the cutoff was 0.4416 and the sensitivity, specificity, positive predictive value, and negative predictive value were 68.7%, 95%, 91.7%, and 77.6%, respectively. The correlation coefficients of all subjects, the hemodialysis group, and the non-hemodialysis group were 0.486, 0.102, and 0.743, respectively. CONCLUSIONS Laser speckle flowgraphy is a noninvasive, rapid, and widely applicable method. Laser speckle flowgraphy using hallucal and thenar index would be helpful to determine the differences between subjects with and without peripheral arterial disease. The correlation between hallucal and thenar index of beat strength of skin perfusion and ankle brachial index indicated that this index was especially useful in the non-hemodialysis group.
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Affiliation(s)
- Kazuhiro Tsunekawa
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Fumio Nagai
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tamon Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ikkei Takashimizu
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Daisuke Yanagisawa
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Karjalainen T, Jokihaara J. A Review and Meta-analysis of Adverse Events Related to Local Flap Reconstruction for Digital Soft Tissue Defects. Hand Clin 2020; 36:107-121. [PMID: 31757343 DOI: 10.1016/j.hcl.2019.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We reviewed the current literature to estimate incidence rates for adverse events with pedicled flaps in the hand. We identified 241 different studies reporting adverse events for 6693 flaps. The average incidence rate was 5.4% and total or partial loss of flap constituted 65% of all reported complications. Flaps with reverse or perforator-based flow may be more prone to vascular complications compared with flaps with antegrade flow or skin pedicle. The incidence rates were acceptable in all flaps (1%-10%) and thus the flap can be chosen primarily based on considerations other than risk of adverse events.
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Affiliation(s)
- Teemu Karjalainen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash Department of Clinical Epidemiology, Cabrini Hospital, Monash University, Malvern, Australia; Department of Surgery, Central Finland Central Hospital, Keskussairaalantie 16, Jyväskylä 40620, Finland.
| | - Jarkko Jokihaara
- Department of Hand Surgery, Tampere University Hospital, TAYS/TUL2, Teiskontie 35, Tampere 33521, Finland; Faculty of Medicine and Health Technology, Tampere University, TAYS/TUL2, Teiskontie 35, Tampere 33521, Finland
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Abstract
The glabrous skin of the palm provides the best color and texture match for reconstruction of palmar aspect of fingers following the principle of reconstructing like with like. Few local axial and perforator flaps have been described of the palm for reconstruction of finger defects. This article reviews the various local flaps based on palmar vessels for digital reconstruction and shares the authors' experiences with similar flaps. Indications, clinical applications, surgical anatomy, and operative techniques of different flaps from palmar tissues are discussed. The authors suggest using these flaps for proximal and smaller defects on the palmar aspect of fingers.
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Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B.J. Govt Medical College, Sassoon Hospital, Pune, Maharashtra, India.
| | - Ameya Bindu
- Department of Plastic Surgery, B.J. Govt Medical College, Sassoon Hospital, Pune, Maharashtra, India
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Das De S, Sebastin SJ. Considerations in Flap Selection for Soft Tissue Defects of the Hand. Clin Plast Surg 2019; 46:393-406. [DOI: 10.1016/j.cps.2019.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Sierakowski A, Ahmed M, Ruston J, Loh CYY. Reverse pedicled flap with use of the superficial palmar branch of the radial artery and venous supercharging for thumb pulp repair. J Hand Surg Eur Vol 2019; 44:537-538. [PMID: 30760095 DOI: 10.1177/1753193419828598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Adam Sierakowski
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, Essex, UK
| | - Mohammed Ahmed
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, Essex, UK
| | - Julia Ruston
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, Essex, UK
| | - Charles Yuen Yung Loh
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, Essex, UK
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Tapan M, İğde M, Yıldırım AR, Yaşar B, Ergani HM, Duru Ç. Reverse Thenar Perforator Flap for Large Palmar and Digital Defects. J Hand Surg Am 2018; 43:956.e1-956.e6. [PMID: 29754756 DOI: 10.1016/j.jhsa.2018.03.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 03/22/2018] [Indexed: 02/02/2023]
Abstract
Reconstruction of large, full-thickness palmar and digital defects is challenging. The glabrous skin of the palm provides excellent color and texture match for palmar hand and digital defects. The reverse thenar perforator flap, which was previously infrequently used, provides a method for primary closure of large glabrous palmar skin defects. Because of the origin of the source vessels, the reverse thenar perforator flap is a good choice for larger radial-sided palmar and finger defects. This flap provides good aesthetic results for both the donor and the recipient.
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Affiliation(s)
- Mehmet Tapan
- Department of Plastic Reconstructive and Aesthetic Surgery, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
| | - Murat İğde
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ali Rıza Yıldırım
- Department of Plastic Reconstructive and Aesthetic Surgery, Igdir Public Hospital, Igdir, Turkey
| | - Burak Yaşar
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Hasan Murat Ergani
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Çağdaş Duru
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
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12
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Abstract
BACKGROUNDS Various flaps elevated from the palm have been widely used for finger and hand reconstruction. Recently, perforator-based free flaps or venous free flaps have received popularity due to several advantages. The cutaneous venous system has been chosen as the circulatory outlet when designing and harvesting the flap from the palmer area due to the small size and thin nature of the flap. However, there have been few descriptions about the anatomy of the palmar cutaneous veins. A more detailed knowledge will be valuable for elevating various flaps from the palmar area. METHODS Whole-body and hand venography with a contrast medium was performed on 9 fresh cadavers. Dissection and investigation of the skin and subcutaneous tissue were performed using a soft x-ray system with a stereogram. During all the processes that involved elevating the tissue, observations were made on the macroscopic structure of the palmar vein. RESULTS In the palm, a complex network of veins are connected with the distal branches of the cephalic vein, basilic vein, and dorsal venous arch. The pattern and geometric formation of the venous network in all cases showed distinctive features according to each region of the palm. The venous branches create a network extending to palmar margins and webs between fingers. CONCLUSIONS Venous arrangement should be considered when designing flaps from the palm to prevent venous congestion and safely extend the length of the flap.
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Sen S, Fitzgerald O'Connor E, Tare M. The free instep flap for palmar and digital resurfacing. J Plast Reconstr Aesthet Surg 2015; 68:1191-8. [DOI: 10.1016/j.bjps.2015.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 12/22/2014] [Accepted: 05/11/2015] [Indexed: 10/23/2022]
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Sinno S, Wilson S, Billig J, Shapiro R, Choi M. Primary melanoma of the hand: An algorithmic approach to surgical management. J Plast Surg Hand Surg 2015; 49:339-45. [DOI: 10.3109/2000656x.2015.1053396] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Gasiunas V, Valbuena S, Valenti P, Le Viet D. Volar perforators of common digital arteries: an anatomical study. J Hand Surg Eur Vol 2015; 40:310-3. [PMID: 24664162 DOI: 10.1177/1753193414528847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The palmar triangle is an area vascularized by perforator arteries arising from the common digital palmar arteries. The aim of this article was to perform an anatomical study of common digital palmar arteries perforators. Twelve injected specimens were included in this study. The purpose was to quantify the number of perforator arteries of each common digital palmar arteries in the 2nd, 3rd, and 4th intermetacarpal space, measure distances between them, between the distal perforator and corresponding commissure, and the distance between the proximal perforator and the superficial palmar arch. Four to eight perforators were arising from common digital palmar arteries of the 2nd, 3rd, and 4th intermetacarpal space. The average distance between perforator arteries was 6.5 mm, between superficial palmar arch and proximal perforator artery - 8.2 mm, between the distal perforator artery and corresponding commissure - 6.3 mm.
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Affiliation(s)
| | - S Valbuena
- Clinica del Deporte, Buenos Aires, Argentina
| | - P Valenti
- Institut de la main, Clinique Jouvenet, Paris, France
| | - D Le Viet
- Institut de la main, Clinique Jouvenet, Paris, France
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Reconstruction of volar skin and soft tissue defects of the digits including the pulp: experience with the free SUPBRA flap. J Plast Reconstr Aesthet Surg 2014; 68:26-34. [PMID: 25249424 DOI: 10.1016/j.bjps.2014.08.064] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 06/30/2014] [Accepted: 08/24/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND The ideal flap for volar defects on the digits should provide glabrous skin, maintain length, be sensate and supple enough to allow unimpeded motion of the joints. When local flap options are either inadequate or unavailable, this constitutes a challenge that usually requires free tissue transfer. We describe our experience of the use of the free transfer of glabrous skin based on the superficial palmar branch of the radial artery (SUPBRA) for digital (volar) reconstruction. METHODS Between May 2005 and June 2011, we used this flap to reconstruct digital defects in 13 patients with mean age of 40.1 years (range 18-68 years) and a follow up range from 0.7 to 3.5 years (mean 1.5 years). The dimension of the flaps ranged from 2 × 5cm to 2 × 10 cm. The indications for surgery included traumatic loss of tissue/amputation, severe pulp space infection, dog bite injury, crush injury/ischaemic loss and salvage of failed local flap. The donor site was closed directly in all cases. RESULTS There were no flap failures. All wounds healed with good functional outcomes with ideal tissue match, minimal donor site morbidity and return of protective sensation despite no neurorrhaphy performed except in one patient. CONCLUSION The free SUPBRA flap has many advantages, approaching ideal replacement for the volar tissues of the fingers, excellent tissue match, minimal donor site morbidity with an excellent camouflaged scar in the mid palmar crease, one operation field, non sacrifice of a major vessel, can be made 'sensory', neurotises well and offers a single site for rehabilitation. We believe that the free SUPBRA flap is a very reliable and useful option in the armoury of the reconstructive hand surgeon.
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17
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Abstract
There are many options for nonmicrosurgical soft tissue coverage of hand wounds, ranging from split thickness skin grafting to pedicled soft tissue transfer, depending on the size, location, blood supply, and depth of the wound. Although many of these techniques have been available for decades, recent advancements in wound management include synthetic dermal substitution, new dressing materials, and variations on previously described or novel pedicled flaps.The goals of coverage include maximizing healing, function, aesthetic appearance, and patient satisfaction, while minimizing donor site morbidity. Optimal management often relies on an individual surgeon's assessment and judgment, as hand wounds can vary greatly and pose unique challenges, and multiple coverage options often exist for each wound. Here, we aim to present useful and up-to-date information on nonmicrosurgical soft tissue coverage for hand reconstruction focusing on recent findings of interest to provide an update on areas with evolving evidence.
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Affiliation(s)
- Jun Matsui
- Washington University in St. Louis, 660 S. Euclid Ave. Campus, Box 8233, St. Louis, MO 63110 USA
| | - Samantha Piper
- Washington University in St. Louis, 660 S. Euclid Ave. Campus, Box 8233, St. Louis, MO 63110 USA
| | - Martin I. Boyer
- Washington University in St. Louis, 660 S. Euclid Ave. Campus, Box 8233, St. Louis, MO 63110 USA
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18
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Doğan F, Çoruh A. Novel Biogeometric Designs of First Dorsal Metacarpal Artery Flap in Hand Reconstruction. J Burn Care Res 2014; 35:e399-405. [DOI: 10.1097/bcr.0000000000000044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Akita S, Kuroki T, Yoshimoto S, Rikihisa N, Satoh K. Reconstruction of a fingertip with a thenar perforator island flap. J Plast Surg Hand Surg 2012; 45:294-9. [DOI: 10.3109/2000656x.2011.634549] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Iwuagwu F, Siddiqui A. Pedicled (antegrade) SUPBRA flap - for wound cover on volar aspect of thumb. J Plast Reconstr Aesthet Surg 2011; 65:678-80. [PMID: 21945339 DOI: 10.1016/j.bjps.2011.08.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 07/18/2011] [Accepted: 08/24/2011] [Indexed: 11/17/2022]
Abstract
A dictum of reconstruction is to replace like with like. Therefore, glabrous skin is best replaced with like tissue from the palm or the soles of the feet. We have previously presented our experience with free tissue from the palm based on the superficial palmer branch of the radial artery to reconstruct defects on the volar aspect of the digits following the original description of this flap by Kamei et al. There are situations where an antegrade pedicled flap from this area lends well as a choice for reconstruction. We describe the use of a pedicled flap from this axis for a defect on the radial aspect of the thumb and we believe it is the first report of its kind.
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Affiliation(s)
- F Iwuagwu
- St. Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, Essex CM1 7ET, UK.
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