1
|
Hollins AW, Mithani SK. Advances in Soft Tissue Injuries Associated with Open Fractures. Hand Clin 2023; 39:605-616. [PMID: 37827613 DOI: 10.1016/j.hcl.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Management of soft tissue injury is a key component in the overall treatment of upper extremity fractures. Hand surgeons must rely on their armamentarium for treating soft tissue deficits for functional outcomes. Understanding the role of fracture fixation and wound adjuncts, including negative pressure wound therapy and dermal regenerative templates, is the keys to success. In addition, detailed knowledge of local and free tissue options is essential for hand reconstruction.
Collapse
Affiliation(s)
- Andrew W Hollins
- Division of Plastic Surgery, Department of Surgery, Duke University Medical Center, Box 3974 Duke Medical Center, Durham, NC 27710, USA
| | - Suhail K Mithani
- Division of Plastic Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27705, USA.
| |
Collapse
|
2
|
Lee G, Kim B, Jeon N, Yoon J, Hong KY, Lim S, Eo S. Versatility of the Posterior Interosseous Artery Flap: Emphasis on Powering Up the Toe Transfer. Hand (N Y) 2023; 18:272-281. [PMID: 34253087 PMCID: PMC10035084 DOI: 10.1177/15589447211028925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Reverse-flow posterior interosseous artery (rPIA) flap is an excellent tool for restoration of defects in the hand and upper extremity, sparing the main arteries to the hand. Its reliability has been well established. MATERIALS AND METHODS Fifty-one cases of rPIA flap involving 49 patients were retrospectively reviewed. The inclusion criteria were age, sex, etiology, size and location of the defect, flap size, number of perforators included, pedicle length, flap inset, donor site coverage, complications, and ancillary procedures. RESULTS This study included 44 men and 5 women, ranging in age between 10 and 73 years. The subjects had soft tissue defects of the hand and upper extremity mainly due to traumatic injuries, including scar contractures of the first web space in 18 cases, thumb amputations in 6 cases, and congenital defects in 1 case. Among the 51 rPIA flap elevations, 3 cases involved flap failure due to the absence of proper pedicle. A fasciocutaneous pattern was observed in 45 cases and a myocutaneous pattern in 3 cases. In 5 cases of unplantable thumb amputations, the rPIA flap was performed for arterial inflow to the secondary toe-to-thumb transfer. Venous congestion of varying degrees was noted in 7 cases involving partial necrosis in 2 cases. During the mean 17 months of follow-up, patients were generally satisfied with the final outcomes. CONCLUSION The rPIA flap can be used not only for soft tissue coverage of the hand and upper extremity but also as a recipient arterial pedicle for a secondary toe-to thumb transfer.
Collapse
Affiliation(s)
- GiJun Lee
- MS Jaegeon Hospital, DaeGu, South Korea
| | - BumSik Kim
- Dongguk University Ilsan Medical Center, Seoul, South Korea
| | | | - JungSoo Yoon
- Dongguk University Ilsan Medical Center, Seoul, South Korea
| | - Ki Yong Hong
- Dongguk University Ilsan Medical Center, Seoul, South Korea
| | - SooA Lim
- Dongguk University Ilsan Medical Center, Seoul, South Korea
| | - SuRak Eo
- Dongguk University Ilsan Medical Center, Seoul, South Korea
| |
Collapse
|
3
|
Barrera-Ochoa S, Sapage R, Alabau-Rodriguez S, Mendez-Sanchez G, Mir-Bullo X, Soldado F. Vascularized Ulnar Periosteal Pedicled Flap for Upper Extremity Reconstruction in Adults: A Prospective Case Series of 11 Patients. J Hand Surg Am 2022; 47:86.e1-86.e11. [PMID: 34016492 DOI: 10.1016/j.jhsa.2021.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We hypothesized that a vascularized ulnar periosteal pedicled flap (VUPPF) is a versatile graft applicable in adult patients that yields good outcomes and is a reliable alternative to other vascularized bone grafts to reduce both the technical demands and donor site morbidity of other options. METHODS We reviewed 11 adult patients who underwent surgical treatment of forearm atrophic nonunion with a VUPPF. Patients' demographics, outcomes (measured by pain on the visual analog scale; Quick Disabilities of the Arm, Shoulder, and Hand score; range of motion; and grip strength), and associated complications were reported. RESULTS Of the 11 patients, 5 had previous surgery in an attempt to treat the nonunion with an autologous cancellous bone graft from the iliac crest or olecranon. The average time from nonunion until the VUPPF was 9 months (SD, ±3 months; range, 6-14 months). The mean visual analog scale score improved considerably after surgery (8.7 vs 0.6), and considerable improvement was also noted in the Quick Disabilities of the Arm, Shoulder, and Hand score (50 vs 6). A notable improvement was seen in grip strength after surgery. Pronation/supination also improved considerably between the preoperative assessment and the final postoperative follow-up. CONCLUSIONS A vascularized ulnar periosteal pedicled flap seems to be a useful and versatile option for a variety of bone union failures of the upper extremity in adults, either at initial presentation or as a salvage technique. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Sergi Barrera-Ochoa
- Hand, Elbow, and Microsurgery Unity (icatMA), Institut Català de Traumatología i Medicina de l'Esport (ICATME), Hospital Universitario Dexeus, Barcelona, Spain
| | - Rita Sapage
- Hand, Elbow, and Microsurgery Unity (icatMA), Institut Català de Traumatología i Medicina de l'Esport (ICATME), Hospital Universitario Dexeus, Barcelona, Spain; Orthopedic and Traumatology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal.
| | - Sergi Alabau-Rodriguez
- Hand, Elbow, and Microsurgery Unity (icatMA), Institut Català de Traumatología i Medicina de l'Esport (ICATME), Hospital Universitario Dexeus, Barcelona, Spain
| | - Gerardo Mendez-Sanchez
- Hand, Elbow, and Microsurgery Unity (icatMA), Institut Català de Traumatología i Medicina de l'Esport (ICATME), Hospital Universitario Dexeus, Barcelona, Spain
| | - Xavier Mir-Bullo
- Hand, Elbow, and Microsurgery Unity (icatMA), Institut Català de Traumatología i Medicina de l'Esport (ICATME), Hospital Universitario Dexeus, Barcelona, Spain
| | - Francisco Soldado
- Pediatric Hand Surgery and Microsurgery Unit, Hospital Vall d'Hebron, Barcelona, Spain; Hospital Vithas San José, Vitoria-Gasteiz, Spain
| |
Collapse
|
4
|
Hasegawa H, Shimizu T, Omokawa S, Kawamura K, Sananpanich K, Mahakkanukrauh P, Tanaka Y. Vascularized pedicled bone graft from the distal radius supplied by the anterior interosseous artery for treatment of ulnar shaft nonunion: An anatomical study of cadavers and a case report. Microsurgery 2020; 40:479-485. [PMID: 32048745 DOI: 10.1002/micr.30566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 12/05/2019] [Accepted: 01/17/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND A vascularized distal radius graft can be a reliable solution for the treatment of refractory ulnar nonunion. The aim of this study is to establish the anatomical basis of a vascularized bone graft pedicled by the anterior interosseous artery and report its clinical application, using cadaveric studies and a case report. METHODS Fourteen fresh frozen cadaveric upper limbs were used. The branches of the anterior interosseous artery (the 2, 3 intercompartmental supraretinacular artery and the fourth extensor compartment artery) were measured at the bifurcation site. The anatomical relationship between the anterior interosseous artery and motor branches of the posterior interosseous nerve was investigated. An anterior interosseous artery pedicled bone flap was used in a 48-year-old woman with refractory ulnar nonunion. RESULTS There were two variations depending on whether the 2,3 intercompartmental supraretinacular artery branched off distally or proximally from the terminal motor branch of the posterior interosseous nerve. The proximal border of the graft was located at an average of 10.5 cm (range, 6.5-12.5 cm) from the distal end of the ulnar head in the distal type (57%) and 17.5 cm (range, 9.5-21.5 cm) in the proximal type (43%). In the clinical application, successfully consolidation was achieved 4 months post-surgery. The patient had not developed any postoperative complications until the 2-year postoperative follow-up. CONCLUSIONS The anterior interosseous artery-pedicled, vascularized distal radius bone graft would be a reliable alternative solution for the treatment of an ulnar nonunion located within the distal one-third of the ulna.
Collapse
Affiliation(s)
- Hideo Hasegawa
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Takamasa Shimizu
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| | - Shohei Omokawa
- Department of Hand Surgery, Nara Medical University, Kashihara, Japan
| | - Kenji Kawamura
- The Limb Trauma Center, Nara Medical University, Kashihara, Japan
| | - Kanit Sananpanich
- Department of Orthopedic Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan
| |
Collapse
|
5
|
Lo CK, Kam WL. Distal ulnar fracture nonunion management: An uncommon case report. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918773963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Isolated distal ulnar fracture is an uncommon injury. Only a few case series that look into the management of ulnar fracture nonunion have been reported in the literature. Case presentation: A middle-aged manual worker presented to us for isolated fracture of his left distal ulna. He received open reduction and fixation of the distal ulnar fracture using distal ulna locking plate. It was complicated with nonunion and he complained of persistent wrist pain. This distal ulnar fracture nonunion was finally treated by Sauve-Kapandji procedure with good functional outcome. Discussion: Displaced distal ulnar fracture should be reduced anatomically with rigid fixation to prevent disruption of the distal radioulnar joint. Fracture nonunion was traditionally managed with revision osteosynthesis and bone grafting. It is, however, technically difficult at the distal ulnar region because of the poor bone stock and lack of soft tissue coverage. Conclusion: We have demonstrated that the Sauvé-Kapandji procedure is a good treatment alternative for distal ulnar fracture nonunion.
Collapse
Affiliation(s)
- Chi Kin Lo
- Department of Orthopaedics & Traumatology, Yan Chai Hospital, Tsuen Wan, Hong Kong
| | - Wing Lok Kam
- Department of Orthopaedics & Traumatology, Yan Chai Hospital, Tsuen Wan, Hong Kong
| |
Collapse
|
6
|
Barrera-Ochoa S, Velez R, Rodriguez-Baeza A, De Bergua-Domingo JM, Knörr J, Soldado F. Vascularized ulnar periosteal pedicled flap for forearm reconstruction: Anatomical study and a case report. Microsurgery 2017; 38:530-535. [DOI: 10.1002/micr.30208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/15/2017] [Accepted: 07/12/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Sergi Barrera-Ochoa
- Orthopedic Surgery Department, Pediatric Upper Extremity Surgery and Microsurgery; Hospital Sant Joan de Deu. Passeig Sant Joan de Deu, 2; Esplugues de Llobregat 08950 Spain
- Hand and Microsurgery Unit; Hospital Universitari Quiron-Dexeus; ICATME. Carrer Sabino de Arana, 5-19, Barcelona 08028 Spain
| | - Roberto Velez
- Orthopedic Surgery Department; Hand Surgery Unit; Hospital Universitari Vall d'Hebron; Passeig Vall d'Hebron 119-129, Barcelona 08035 Spain
| | - Alfonso Rodriguez-Baeza
- Human Anatomy and Embryology Department, Faculty of Medicine; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Josep Maria De Bergua-Domingo
- Orthopedic Surgery Department, Pediatric Upper Extremity Surgery and Microsurgery; Hospital Sant Joan de Deu. Passeig Sant Joan de Deu, 2; Esplugues de Llobregat 08950 Spain
| | - Jorge Knörr
- Orthopedic Surgery Department, Pediatric Upper Extremity Surgery and Microsurgery; Hospital Sant Joan de Deu. Passeig Sant Joan de Deu, 2; Esplugues de Llobregat 08950 Spain
| | - Francisco Soldado
- Orthopedic Surgery Department, Pediatric Upper Extremity Surgery and Microsurgery; Hospital Sant Joan de Deu. Passeig Sant Joan de Deu, 2; Esplugues de Llobregat 08950 Spain
| |
Collapse
|
7
|
Kamrani RS, Farhoud A, Nabian MH, Zanjani LO, Farzan M. Vascularized posterior interosseous pedicled bone grafting for infected forearm nonunion. J Hand Surg Eur Vol 2016; 41:441-7. [PMID: 26307139 DOI: 10.1177/1753193415601041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/05/2015] [Indexed: 02/03/2023]
Abstract
Infected forearm nonunion is challenging to treat. We have used a vascularized pedicled bone graft from the distal ulna based on the posterior interosseous artery to treat forearm nonunion with current or previous signs of infection in six patients. Bone union was achieved after a mean of 3.8 months. After a mean follow-up of 25.7 months, no signs of persistent or reactivation of infection were seen in any patient. The mean Quick DASH score significantly improved from 77.4 to 17.6. In addition, the active range of motion of the wrist improved significantly after surgery. In our patients, a vascularized posterior interosseous pedicled bone from the distal ulna is a reliable vascularized bone graft for managing infected forearm nonunion.
Collapse
Affiliation(s)
- R S Kamrani
- Department of Orthopaedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Joint Reconstruction Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - A Farhoud
- Department of Orthopaedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Joint Reconstruction Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - M H Nabian
- Department of Orthopaedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - L O Zanjani
- Department of Orthopaedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - M Farzan
- Joint Reconstruction Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
8
|
Abstract
Perforator flaps are an excellent reconstructive option for a functional upper limb reconstruction. This article explores the physiology and general principles of perforator flaps and their indications for use in reconstruction of the upper extremity. Workhorse perforator flaps of the upper extremity, such as the radial artery perforator, ulnar artery perforator, lateral arm perforator, posterior interosseous artery, first dorsal metacarpal artery perforator and perforator-based propeller flaps, are discussed in greater detail.
Collapse
Affiliation(s)
- Sarah E Appleton
- Plastic and Reconstructive Surgery, Dalhousie University, 4443-1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada
| | - Steven F Morris
- Departments of Surgery, Anatomy and Neurobiology, Dalhousie University, 4443-1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada.
| |
Collapse
|
9
|
Abstract
In isolation, distal ulna fractures are rare. They are often found in conjunction with distal radius fractures, and the complexity of the interaction of the distal ulna with the radioulnar joint and triangular fibrocartilage complex makes understanding and treatment of distal ulna fractures challenging. Fixation of distal ulna fractures can be problematic owing to comminution making reduction challenging. A thin soft tissue can lead to hardware prominence and necessitate implant removal. In this Current Concepts article, we review the anatomy, pathology, and treatment of distal ulna fractures as well as potential complications and salvage procedures.
Collapse
Affiliation(s)
- Todd A Richards
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia
| | - D Nicole Deal
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia.
| |
Collapse
|