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Faderani R, Mann A, Kokkinos C, Nikkhah D. The free Thenar flap for thumb pulp reconstruction: A case report. Microsurgery 2023; 43:847-854. [PMID: 37415380 DOI: 10.1002/micr.31089] [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: 12/29/2022] [Revised: 05/21/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
The thumb is acknowledged to contribute significantly to hand function, accounting for up to 40% of its overall capability. Consequently, injuries affecting the thumb can have a profound impact on the quality of life experienced by patients. When it comes to the surgical reconstruction of thumb injuries, the primary objective is to promptly provide coverage of the affected area with glabrous skin, thus preserving both the length and functionality of the thumb. Managing injuries specifically involving the thumb pulp can be particularly challenging due to the digit's size and vital role. Acquiring an adequate amount of glabrous soft tissue poses a difficulty in such cases. Various reconstructive approaches, encompassing a range of options on the reconstructive ladder, have been documented for thumb pulp injuries. The most popular options include pedicled flaps and free flaps obtained from both the hands and feet. However, a consensus regarding the optimal method for reconstructing the thumb pulp has yet to be reached. We present a case of total thumb pulp reconstruction for a 40 × 30 mm defect using the free thenar flap in a 65-year-old carpenter who sustained a work-related injury. This flap was designed and raised on the superficial branch of the radial artery with a single subcutaneous vein and a branch of the palmar cutaneous nerve, the flap measured 43 × 32 mm. It was inset transversely with an end-to-end arterial anastomosis to the ulnar digital artery, venous anastomosis to the dorsal digital vein and nerve coaptation to the ulnar digital nerve. The postoperative course was uneventful, and the patient was discharged the following day without any complications. Eight months after surgery, the patient was extremely satisfied with the results of the procedure in terms of both function and appearance. The patient had experienced an improvement in function, sensation, and aesthetics. The patient had a QuickDASH disability/symptom score of 15.91 and a QuickDASH work module score of 18.75; the range of motion in the treated thumb was almost the same as the opposite thumb. The patient successfully resumed work three weeks following the procedure, initially with modified duties, and fully regained their work capacity within six weeks. As the patient's primary concern was their ability to return to work, the utilization of a free thenar flap offered several distinct advantages. These included minimal post-operative complications, facilitated by a single operative site, allowing for reconstruction under regional anesthesia. Moreover, the procedure was conducted in a single stage, enabling the patient to be discharged on the same day without the need for further procedures. Furthermore, similar to several other reconstructive options for the thumb, the utilization of a free thenar flap offered the advantage of providing high-quality, like-for-like glabrous tissue.
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Affiliation(s)
- Ryan Faderani
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
- UCL Medical School Division of Surgical Sciences UCL, University College London Medical School, UCL, London, UK
| | - Ahdam Mann
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Constantinos Kokkinos
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Dariush Nikkhah
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
- UCL Medical School Division of Surgical Sciences UCL, University College London Medical School, UCL, London, UK
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Du W, Zhu F, Zhang H, Yang J, Zhuang W, Hou Q. Another new attempt to repair finger pulp defects: retrograde island flap bridge transfer of the adjacent phalangeal artery combined with vascular pedicle tubular skin grafting. J Int Med Res 2022; 50:3000605221082892. [PMID: 35225699 PMCID: PMC8894969 DOI: 10.1177/03000605221082892] [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: 11/17/2022] Open
Abstract
This study investigated the surgical method and therapeutic effect of retrograde island flap bridge transfer of the adjacent phalangeal artery combined with vascular pedicle tubular skin grafting to repair finger pulp defects. From June 2008 to May 2020, 21 fingers (19 patients) were repaired using this method. The postoperative flap survival rate and complications, and the clinical effect, were evaluated. All flaps survived, and all patients were followed-up for 12 to 46 months. The static two-point discrimination (2PD) was 7 to 11 mm, no apparent complications were observed in the donor area and the McIndoe cold intolerance symptom severity (CISS) scores indicated mild severity. The Michigan hand outcome questionnaire (MHQ) indicated that all patients were satisfied with their overall hand appearance and function. Results were excellent in 15 cases and good in 4 cases, according to the Dargan function evaluation (DFE). It is safe and effective to repair finger pulp defects with a retrograde island flap bridge transfer of the adjacent phalangeal artery combined with vascular pedicle tubular skin grafting. This skin flap has the advantages of simple severing, good texture and concealed donor area, which is convenient for early postoperative functional exercise of the finger.
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Affiliation(s)
- Weibin Du
- Research Institute of Orthopedics, the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, 312001, China.,Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, 312001, China
| | - Fangbing Zhu
- Research Institute of Orthopedics, the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, 312001, China.,Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, 312001, China
| | - HeLou Zhang
- Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Jun Yang
- Research Institute of Orthopedics, the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, 312001, China.,Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, 312001, China
| | - Wei Zhuang
- Research Institute of Orthopedics, the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, 312001, China.,Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, 312001, China
| | - Qiao Hou
- Research Institute of Orthopedics, the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, 312001, China.,Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, 312001, China
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Xu L, Liu Z, Liu S, Jorgensen AM, Hou R, Ju J. Repair of Compound Dorsal Defects of the Digits Using a Free Antegrade Palmaris Longus Tendocutaneous Venous Flap. J Hand Surg Am 2022; 48:510.e1-510.e5. [PMID: 35031123 DOI: 10.1016/j.jhsa.2021.11.023] [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] [Received: 01/31/2021] [Revised: 09/10/2021] [Accepted: 11/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the clinical effect of repairing small dorsal digit compound tissue defects using a free palmaris longus tendocutaneous flap nourished by venous blood. METHODS In a retrospective analysis of patients treated between March 2010 and October 2017, 18 patients were identified as having small compound tissue defects, which were repaired using a free palmaris longus tendocutaneous flap nourished by venous blood. The average age of the patients, including 15 male and 3 female patients, was 34 years (range, 22-55 years). The mean wound size was 6 cm2 (range, 2.0 × 1.5 to 3.5 × 2.0 cm2). All the patients had dorsal defects. The average length of extensor tendon defect was 2.0 cm (range, 1.0-3.0 cm). The mean area of the flap was 7 cm2 (range, 2.5 × 2.0 to 4.0 × 3.5 cm2). The donor sites were primarily closed. RESULTS All 18 flaps survived. A vascular crisis due to a venospasm occurred within 48 hours in 3 flaps, but ultimately, all the flaps survived. The patients were followed-up for a mean period of 10 months (range, 3-15 months). All the patients returned to their previous work after 10-12 weeks. No pain or scar contracture was reported in either the recipient or donor site. CONCLUSIONS The free antegrade palmaris longus tendocutaneous venous flap enabled the repair of compound tissue defects of the dorsal digit, resulting in acceptable aesthetics, repaired tendon defects, and wound coverage. This surgical method is an option for the reconstruction of small compound defects of digits with extensor defects. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Lei Xu
- Department of Hand surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhijin Liu
- Department of Hand surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou, China
| | - Shenzhe Liu
- Department of Hand surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou, China
| | - Adam M Jorgensen
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC
| | - Ruixing Hou
- Department of Hand surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou, China.
| | - Jihui Ju
- Department of Hand surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou, China.
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周 健, 郑 玉, 魏 在, 聂 开, 肖 顺, 黄 广, 刘 志, 李 海, 金 文, 陈 伟. [Free transplantation of medial plantar Flow-through venous flap for primary repairing children's finger wounds with digital artery defect]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1182-1185. [PMID: 34523286 PMCID: PMC8444137 DOI: 10.7507/1002-1892.202104101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/27/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the feasibility and effectiveness of free transplantation of medial plantar Flow-through venous flap for primary repairing children's finger wounds with digital artery defect. METHODS Between July 2016 and October 2020, 9 children who suffered finger wounds with digital artery defect were primary repaired with free transplantation of medial plantar Flow-through venous flap. There were 6 boys and 3 girls, with an average age of 6.8 years (range, 4-13 years). The defects were caused by heavy weight puncture injury in 5 cases and strangulation injury in 4 cases. Among them, there were 3 cases of index finger wounds, 3 cases of middle finger wounds, 2 cases of ring finger wounds, and 1 case of little finger wounds. The wound area ranged from 1.8 cm×1.5 cm to 4.0 cm×2.5 cm. The time from injury to operation was 1.3-8.6 hours, with an average of 4.8 hours. The flap area ranged from 2.0 cm×1.6 cm to 4.2 cm×2.6 cm. After the flaps were inverted, the veins were used to bridge the finger arteries while repairing the wounds. The donor site of the foot was sutured directly in 4 cases, and repaired with full-thickness skin grafts in 5 cases. RESULTS All flaps survived, and hand wounds healed by first intention; 8 cases of foot donor site wounds healed by first intention, and 1 case had partial necrosis in the marginal area of the skin graft, which healed after dressing change. All 9 children were followed up 3-24 months, with an average of 9 months. The color and texture of the flap were similar to those of the surrounding normal skin, and the protective feeling was restored. The two-point discrimination of the flap was 7-10 mm, with an average of 8 mm. At last follow-up, according to the upper limb function evaluation standard of Hand Surgery Society of Chinese Medical Association, the finger function was excellent in 5 cases and good in 4 cases. There was no ulcer formation and scar hyperplasia in the foot donor site, which did not affect walking. CONCLUSION The free transplantation of medial plantar Flow-through venous flap is an ideal repair method for repairing children's finger wounds with digital artery defect. It has the advantages of simple flap extraction, thin flap, similar color and texture to the skin of the hand, and concealed donor site.
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Affiliation(s)
- 健 周
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
| | - 玉岑 郑
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
| | - 在荣 魏
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
| | - 开瑜 聂
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
| | - 顺娥 肖
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
| | - 广涛 黄
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
| | - 志远 刘
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
| | - 海 李
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
| | - 文虎 金
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
| | - 伟 陈
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
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Gu S, Fu H, Huang Y, Xie R. Flow-through arterialized venous free thenar flaps for palmar soft tissue defects in fingers. J Int Med Res 2021; 49:300060521991032. [PMID: 33616458 PMCID: PMC7903837 DOI: 10.1177/0300060521991032] [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: 11/16/2022] Open
Abstract
Objective To evaluate the efficacy of venous free thenar flaps for reconstructing palmar soft tissue defects in fingers. Methods From December 2018 to October 2019, 11 patients with palmar soft tissue defects in fingers were treated using venous free thenar flaps. At the final follow-up, the range of thumb radial and palmar abduction on the injured side and opposite side was calculated. The total active movement (TAM) of the injured and opposite fingers and flap sensibility recovery were also recorded. Results The mean follow-up time was 13.4 months, all flaps survived, and all wounds at the donor sites healed with no skin necrosis. At the last follow-up, the average range of thumb radial abduction and thumb palmar abduction on the injured side was 96.6% and 95.9% of the value on the opposite side, respectively. The average TAM of the injured fingers was 98.2% of the value of the opposite fingers. Sensation in the flaps was restored to grade S2 to S3. Conclusion Venous free thenar flaps can be alternatives for reconstructing palmar soft tissue defects in fingers.
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Affiliation(s)
- Song Gu
- Trauma Center, Shanghai General Hospital, 56694Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Huichao Fu
- Trauma Center, Shanghai General Hospital, 56694Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yinjun Huang
- Trauma Center, Shanghai General Hospital, 56694Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Renguo Xie
- Trauma Center, Shanghai General Hospital, 56694Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Kawakatsu M. Reply: Comment on 'Free medialis pedis venous flap transfer for reconstruction of volar finger defects: Clinical application and esthetic evaluation'. J Plast Reconstr Aesthet Surg 2019; 72:1576-1606. [PMID: 31147088 DOI: 10.1016/j.bjps.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Motohisa Kawakatsu
- Department of Plastic and Reconstructive Surgery, Sumiya Orthopaedic Hospital, 337, Yoshida, Wakayama-shi, Wakayama 640-8343, Japan.
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Škrlec A, Henney J, Henderson J. Re "Free medialis pedis venous flap transfer for reconstruction of volar finger defects: Clinical application and esthetic evaluation". J Plast Reconstr Aesthet Surg 2019; 72:1576-1606. [PMID: 31129043 DOI: 10.1016/j.bjps.2019.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/06/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Anže Škrlec
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road, BS10 5NB Bristol, United Kingdom.
| | - James Henney
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road, BS10 5NB Bristol, United Kingdom
| | - James Henderson
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, Southmead Road, BS10 5NB Bristol, United Kingdom
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