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Farlow JL, McCrary HC, Meeker M, Alexander J, Haring CT, Old MO, Kang SY, Rohde SL, Seim NB. The osteocutaneous radial forearm free flap: A multidisciplinary review of the evidence. Oral Oncol 2024; 157:106925. [PMID: 39024698 DOI: 10.1016/j.oraloncology.2024.106925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/31/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024]
Abstract
The osteocutaneous radial forearm (OCRFF) is a versatile free flap option for bony defects of the head and neck, given the thinness and pliability of the forearm cutaneous paddle, pedicle length, reliability, lack of atherosclerosis, and functional concerns common to other osseous donor sites. The OCRFF was once associated with a high risk of radial fracture, in addition to concerns about the quality and durability of bone stock for osseous reconstruction, particularly for the mandible. Following the introduction of prophylactic plating of the radius, the incidence of symptomatic radial fracture has drastically decreased. Furthermore, modifications of the bony osteotomies and other evolutions of this flap harvest have increased the use of the OCRFF throughout the head and neck. Despite these advantages, the OCRFF is not widely utilized by microvascular reconstructive surgeons due to perceived limitations and risks. Herein, we present a multidisciplinary, contemporary review of the harvest technique, outcomes, and perioperative management for the OCRFF.
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Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, OH, USA; Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Hilary C McCrary
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, OH, USA; Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA
| | - Molly Meeker
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - John Alexander
- Department of Orthopaedics, The Ohio State University, Columbus, OH, USA
| | - Catherine T Haring
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Matthew O Old
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Stephen Y Kang
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Sarah L Rohde
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nolan B Seim
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, OH, USA.
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McCrary HC, Farlow JL, Alexander J, Haring CT, Kang SY, Old MO, Seim NB. The osteocutaneous radial forearm free flap: A pictorial essay. Head Neck 2024; 46:1533-1541. [PMID: 38595113 DOI: 10.1002/hed.27745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/09/2024] [Indexed: 04/11/2024] Open
Abstract
The osteocutaneous radial forearm free flap (OCRFFF) is a versatile flap with the ability to reconstruct complex defects. We detail the techniques necessary to harvest an OCRFFF, including an outline on making 90-degree osteotomies to maximize bone harvest. In this pictorial essay, we provide illustrations of the anatomy and surgical techniques necessary for OCRFFF harvest. Detailed discussion is provided on how to protect the perforators to the bone and the approach to making osteotomies in a 90-degree fashion. The approach for prophylactic plating of the radius to prevent radius fractures is outlined. A case presentation on the real-life utilization of this flap is included. The OCRFFF is an excellent head and neck reconstructive option. While there are limitations to its use for patients requiring dental rehabilitation or long/anterior mandibular defects, for the right patient and indication it has shown great success in reconstructive efforts.
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Affiliation(s)
- Hilary C McCrary
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Janice L Farlow
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
- Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - John Alexander
- Department of Orthopaedic Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Catherine T Haring
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Stephen Y Kang
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Matthew O Old
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Nolan B Seim
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
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Czerniecki S, Mishu M, Schmucker R. Metacarpal and Phalangeal Nonunions. Hand Clin 2024; 40:129-139. [PMID: 37979984 DOI: 10.1016/j.hcl.2023.09.003] [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: 11/20/2023]
Abstract
The majority of phalangeal and metacarpal fractures will proceed to union when appropriately treated. However, when a nonunion does occur, it can lead to significant functional impairment for patients and societal costs. Operative intervention is typically required in these cases, but the technique can vary depending on each individual patient scenario. This article provides an overview of nonunions of the metacarpals and phalanges in the hand, including incidence, risk factors, current treatment options, and postoperative care.
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Affiliation(s)
- Stefan Czerniecki
- Department of Plastic and Reconstructive Surgery, The Ohio State University Columbus, OH, USA
| | - Mark Mishu
- Department of Plastic and Reconstructive Surgery, The Ohio State University Columbus, OH, USA
| | - Ryan Schmucker
- Department of Plastic and Reconstructive Surgery, The Ohio State University Columbus, OH, USA.
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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.
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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.
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Capito AE, Hansen BK, Schmitt MW, Beck JH, Cripe BA, Apel PJ. Osteocutaneous Radial Forearm Flap: Harvest Technique and Prophylactic Volar Locked Plating. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5449. [PMID: 38025608 PMCID: PMC10681442 DOI: 10.1097/gox.0000000000005449] [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: 05/27/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023]
Abstract
Background The osteocutaneous radial forearm (OCRF) flap is a variation of the traditional radial forearm flap with incorporation of an anterolateral segment of corticocancellous bone of the radius, periosteum, and overlying skin. The OCRF flap is indicated in traumatic injuries or extirpation defects with segmental bone loss and is well suited to foot and ankle reconstruction due to its thin pliable skin. Methods In this single-center case series, a retrospective review was conducted to identify patients who underwent OCRF free flap for foot and ankle reconstruction that required harvest of more than 50% of the cross-sectional area of the radius with prophylactic volar locked plating of the donor site. Outcome measures included flap failure rates, postoperative fracture, thrombotic events, time to follow-up, and time to full weightbearing. Flap harvest technique is extensively discussed. Results Six cases were included in this series. There were no flap failures or thrombotic events. Recipient site healing was confirmed in all patients, with partial distal skin paddle loss in one patient requiring operative debridement. No patients sustained donor site complications or functional impairment. Full lower extremity weightbearing was achieved at 12.4 ± 3.3 weeks after surgery. Conclusions The OCRF free flap transfer provides a reliable means of obtaining thin, supple soft tissue coverage with a large, vascularized segment of bone for reconstruction in the foot and ankle. Here, we describe use of more than 50% of the cross-sectional area of the radius with volar locked prophylactic plating. These updates expand use of this reconstructive technique.
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Affiliation(s)
- Anthony E. Capito
- From Section of Plastic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Va
| | | | - Mark W. Schmitt
- Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, Va
| | - Jadon H. Beck
- Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, Va
| | - Brian A. Cripe
- From Section of Plastic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Va
| | - Peter J. Apel
- Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, Va
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Chappell AG, Ramsey MD, Dabestani PJ, Ko JH. Vascularized Bone Graft Reconstruction for Upper Extremity Defects: A Review. Arch Plast Surg 2023; 50:82-95. [PMID: 36755653 PMCID: PMC9902088 DOI: 10.1055/s-0042-1758639] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 08/04/2022] [Indexed: 02/09/2023] Open
Abstract
Upper extremity reconstruction may pose clinical challenges for surgeons due to the often-critical, complex functional demands of the damaged and/or missing structures. The advent of vascularized bone grafts (VBGs) has aided in reconstruction of upper extremity (UE) defects due to their superior regenerative properties compared with nonvascularized bone grafts, ability to reconstruct large bony defects, and multiple donor site options. VBGs may be pedicled or free transfers and have the potential for composite tissue transfers when bone and soft tissue are needed. This article provides a comprehensive up-to-date review of VBGs, the commonly reported donor sites, and their indications for the treatment of specific UE defects.
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Affiliation(s)
- Ava G. Chappell
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew D. Ramsey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Parinaz J. Dabestani
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Jason H. Ko
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Address for correspondence Jason H. Ko, MD, MBA, Associate Professor, Program Director Plastic Surgery Residency, Division of Plastic and Reconstructive SurgeryDepartment of Orthopedic Surgery, Northwestern University Feinberg School of MedicineChicago, IL 60611
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Tapan M, Yildirim AR, Igde M, Ünlü RE, Yasar B. An unusual Case of a segmental composite Hand Replantation. HANDCHIR MIKROCHIR P 2023; 55:75-77. [PMID: 35098517 DOI: 10.1055/a-1714-8587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mehmet Tapan
- Akdeniz University; Plastic, Reconstructive and Aesthetic Surgery
| | | | - Murat Igde
- Ankara City Hospital; Plastic, Reconstructive and Aesthetic Surgery
| | | | - Burak Yasar
- Ankara City Hospital; Plastic, Reconstructive and Aesthetic Surgery
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Hill JR, Boyer MI, Chamberlain AM. Radial Forearm Vascularized Osteomuscular Flap for Proximal Ulnar Deficiency After Revision Total Elbow Arthroplasty: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00038. [PMID: 35108225 DOI: 10.2106/jbjs.cc.21.00558] [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: 06/14/2023]
Abstract
CASE A 61-year-old woman presented with a failed proximal ulna allograft-prosthetic composite after revision total elbow arthroplasty (TEA). The ulnar deficiency was addressed using an osteomuscular flap from the distal radius pedicled on the radial artery. At final follow-up, she had minimal pain and a flexion-extension arc of 0° to 130°. Radiographs demonstrated graft incorporation and a stable TEA construct. CONCLUSION This demonstrates utilization of a vascularized osteomuscular flap from the radius for treatment of proximal ulnar deficiency in the setting of revision TEA. This technique offers an alternative option for the challenge of a failed TEA with ulnar bone loss.
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Affiliation(s)
- J Ryan Hill
- Washington University in St Louis, St Louis, Missouri
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Aleksandrov NM, Petrov SV, Kuptsov DA, Petrov MS. Reconstruction of Fingers Using Skin-Bone Grafts with Microvascular Anastomoses. Sovrem Tekhnologii Med 2020; 12:16-22. [PMID: 34513033 PMCID: PMC8353708 DOI: 10.17691/stm2020.12.1.02] [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: 06/04/2019] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to present a clinical and anatomical rationale for transplantation of skin-bone grafts with microvascular anastomoses for treating terminal and segmental defects of the hand and fingers. MATERIALS AND METHODS Finger and metacarpal bones were reconstructed in 25 hands of 25 patients by transplanting skin-bone tubular fragments with microvascular anastomoses. Transplants from the second metatarsal bone (n=22) and fibula (n=3) were used. Clinical, radiological, morphological, biomechanical, biophysical, and statistical research methods were used. The developed technology is adjustable to individual vascular anatomy of the foot. The proposed use of non-free skin-fat flaps and skin-bone fragments with microvascular anastomoses has been implemented for reconstructing lost segments. RESULTS The engraftment of skin-bone fragments was observed in 25 cases. In two cases, partial necrosis of the transplants was detected. Sufficient resistance of the transplanted bone graft to resorption was noted. According to the X-ray evidence, the length of the finger with the metacarpal bone after surgery was 8.44±0.32 cm, in the short term after surgery - 8.10±0.36 cm, and in the long term - 7.87±0.45 cm, indicating mild resorption. We used an individual approach to the transplant selection, which made it possible to obtain generally good long-term results in 3 patients, and satisfactory results - in 22 patients. CONCLUSION The study showed the feasibility of transplanting skin-bone fragments with microvascular anastomoses for replacing various anatomical defects of the hand and fingers. The proposed modification takes into account the variability of vascular anatomy of the donor region.
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Affiliation(s)
- N M Aleksandrov
- Leading Researcher, Microsurgical Department, Institute of Traumatology and Orthopedics, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
- Leading Researcher, Microsurgical Department, Institute of Traumatology and Orthopedics, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
- Clinical Resident, Institute of Traumatology and Orthopedics, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
- Associate Professor, Department of Surgery, The University of Auckland, Private Bag 92019, Victoria St., Auckland, 1142, New Zealand
| | - S V Petrov
- Leading Researcher, Microsurgical Department, Institute of Traumatology and Orthopedics, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
- Leading Researcher, Microsurgical Department, Institute of Traumatology and Orthopedics, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
- Clinical Resident, Institute of Traumatology and Orthopedics, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
- Associate Professor, Department of Surgery, The University of Auckland, Private Bag 92019, Victoria St., Auckland, 1142, New Zealand
| | - D A Kuptsov
- Leading Researcher, Microsurgical Department, Institute of Traumatology and Orthopedics, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
- Leading Researcher, Microsurgical Department, Institute of Traumatology and Orthopedics, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
- Clinical Resident, Institute of Traumatology and Orthopedics, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
- Associate Professor, Department of Surgery, The University of Auckland, Private Bag 92019, Victoria St., Auckland, 1142, New Zealand
| | - M S Petrov
- Leading Researcher, Microsurgical Department, Institute of Traumatology and Orthopedics, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
- Leading Researcher, Microsurgical Department, Institute of Traumatology and Orthopedics, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
- Clinical Resident, Institute of Traumatology and Orthopedics, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
- Associate Professor, Department of Surgery, The University of Auckland, Private Bag 92019, Victoria St., Auckland, 1142, New Zealand
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Small Finger Osteocutaneous Fillet Flap for Reconstruction in Ring Finger Trauma. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2477. [PMID: 31772900 PMCID: PMC6846318 DOI: 10.1097/gox.0000000000002477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/06/2019] [Indexed: 11/27/2022]
Abstract
Finger amputations are common injuries which result in significant long-term morbidity and loss of function. In this report, we describe a creative operative solution for a 21-year-old man who was in a motorcycle crash and sustained severely comminuted open fractures of the left small and ring fingers with severe crush injury and soft tissue avulsion. Of the tissues and bones in the small finger, only the distal half of the proximal phalanx remained intact and was vascularized via the remaining ulnar neurovascular bundle. In the ring finger, the extensor mechanism and ulnar neurovascular bundle were avulsed and the distal half of the proximal phalanx was absent, but the flexor tendons were intact. A small finger ray amputation was performed. Then, using an osteocutaneous fillet flap based on the ulnar neurovascular bundle from the small finger, the bony gap and soft tissue deficits in the ring finger were reconstructed. The ring finger extensor tendon was then reconstructed. Subsequently, the patient had evidence of bony union on follow-up X-rays and he had a sensate filet flap over the ulnar aspect of the ring finger. This case demonstrates the creative use of a "spare-parts" osteocutaneous fillet flap in the reconstruction of a traumatic finger injury. This example highlights the importance of assessing all available reconstructive options to avoid the morbidity of a finger amputation.
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Abstract
Background: The differential for soft tissue tumors of the hand and upper limb is broad. Hematologic malignancy remains quite low on the differential for soft tissue tumors involving the hand, and there is little in the literature describing surgical management of such cutaneous manifestations. When the tumor is large or involves the thumb, careful consideration of reconstructive options is required. Methods: We present a rare case of an aggressively enlarging mycosis fungoides, a cutaneous T-cell lymphoma tumor, involving the thumb. This tumor had a history of multiple failed treatment attempts, including radiation and chemotherapy. Results: Our surgical plan was a reverse radial forearm osteocutaneous flap. Conclusion: A reverse radial osteocutaneous forearm flap was successfully used to avoid thumb amputation and preserve thumb function.
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Affiliation(s)
- Giancarlo McEvenue
- University of Toronto, Ontario, Canada,Giancarlo McEvenue, Division of Plastic and Reconstructive Surgery, University of Toronto, The Rotman/Stewart Building, 149 College Street, 5th Floor, Suite 508, Toronto, Ontario, Canada M5T 1P5.
| | | | - Paul Binhammer
- University of Toronto, Ontario, Canada,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Song D, Deng X, Chen Y, Xie S, Zhou X. Thinned chimeric radial collateral artery perforator flap in complex distal thumb reconstruction. Arch Orthop Trauma Surg 2015; 135:1623-31. [PMID: 26377731 DOI: 10.1007/s00402-015-2324-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Tissue loss accompanied by bone defects in the thumb is a challenging reconstruction problem. Traditional repair methods are unsatisfactory. METHODS Microsurgical thumb reconstruction was performed using 13 thinned chimeric radial collateral artery (RCA) perforator flaps. The flap was created with a thinned skin paddle and humeral bone segments using independent perforators. Primary defatting was completed when the thickness of the perforator entry was approximately similar to that in the periphery. The posterior cutaneous nerve of the arm was carried to make a sensory flap. Defects were 8.5 × 4.5 cm(2) on average (ranging in size from 4.5 × 1.5 to 15.0 × 6.0 cm(2)), and flap size was 9.0 × 5.5 cm(2) on average (ranging in size from 5.0 × 2.0 to 16.0 × 7.0 cm(2)), whereas the humeral fragments were 2.0 × 1.0 cm(2) on average (ranging in size from 1.5 × 0.5 to 4.0 × 1.5 cm(2)). All data were expressed as mean ± SD. The cosmetic appearance of the donor and recipient sites, Kapandji opposition score and static two-point discrimination of the operated thumb were evaluated during a follow-up visit. RESULTS Follow-up time was 16.6 months (ranging from 14 to 28 months). Flap thickness before defatting, measured immediately after flap elevation was 14.5 mm (ranging from 10.0 to 25.0 mm). Average flap thickness after defatting was 3.5 mm (ranging from 3.0 to 6.0 mm). Venous congestion occurred in two cases. Successful microsurgical revision was achieved in both cases. All flaps survived. Bone components achieved union in all cases at an average period of 4.8 months (ranging from 3 to 6 months). Based on Kapandji opposition score, the mean thumb opposition score was 6. The mean sensation of flap was 7.5 mm (ranging from 6 to 11 mm). No further flap revision or defatting procedures were required in all cases. Cosmetically acceptable results were achieved for all patients. CONCLUSIONS Findings proved that thinned chimeric RCA perforator flap is a beneficial microsurgical alternative for reconstructing complex bone and soft tissue defects in thumb.
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Affiliation(s)
- Dajiang Song
- Department of Head and Neck Surgery, Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China.,Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Xiangwu Deng
- Hand Surgical Centre, Nanhua Hospital, Nanhua University, Henyang, China
| | - Yanmin Chen
- Hand Surgical Centre, Nanhua Hospital, Nanhua University, Henyang, China
| | - Songlin Xie
- Hand Surgical Centre, Nanhua Hospital, Nanhua University, Henyang, China. .,Department of Orthopaedics, Xiangya Hospital of Central South University, Changsha, China.
| | - Xiao Zhou
- Department of Head and Neck Surgery, Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China.
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Simsek T, Engin MS, Demir A, Tayfur V, Eroglu L. Reconstruction of hand injuries with multiple metacarpal defects using free fibular osteoseptocutaneous flap. Microsurgery 2012; 32:520-6. [DOI: 10.1002/micr.21977] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 02/03/2012] [Accepted: 02/06/2012] [Indexed: 11/07/2022]
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Abstract
One-stage osteoplastic reconstruction of the thumb is based on a reverse-flow forearm osteocutaneous flap. It is indicated in traumatic loss of the thumb at or around metacarpophalangeal joint level in situations where replacement with a toe is not feasible or patient desires against such a transfer. It is relatively an easier method of thumb reconstruction and does not require microsurgical expertise. Donor-site morbidity is small. Complications include delayed wound healing at donor site, radius fracture, and venous congestion. This technique is a useful reconstruction option for traumatic loss at the middle-third level of the thumb.
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Yajima H, Kobata Y, Kawamura K, Shigematsu K, Kawate K, Tamai S. Radial forearm flaps for reconstruction in hand surgery. ACTA ACUST UNITED AC 2009; 38:112-7. [PMID: 15202669 DOI: 10.1080/02844310310014847] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Thirty-seven patients were treated using distally-based island radial forearm flaps. There were 31 men and six women. Reconstructed sites involved the dorsum of the hand (n = 17), the thumb (n = 11), the fingers (n = 5), the first web (n = 3), and the palm (n = 1). Sensory flaps were transferred in 15 cases, osteocutaneous flaps in six, and tendocutaneous flaps in eight. All the flaps survived. There were five donor-site complications, but no functional disturbances. Three patients had symptoms of cold intolerance. There were no radial fractures. In the six cases with osteocutaneous flaps, a mean of 2.6 months (range 2-3) was needed to obtain bony union. Among the eight cases with tendocutaneous flaps, postoperative tenolysis was required in two cases, and finally seven achieved a satisfactory outcome. The mean moving 2-point discrimination of the sensory flaps was 13 mm.
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Affiliation(s)
- Hiroshi Yajima
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
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16
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Pedicled and free radial forearm flaps for reconstruction of the elbow, wrist, and hand. Plast Reconstr Surg 2008; 121:887-898. [PMID: 18317137 DOI: 10.1097/01.prs.0000299924.69019.57] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A single surgeon's experience with 67 pedicled and free radial forearm flaps for reconstruction of the elbow, wrist, and hand was analyzed retrospectively. METHODS Fifty-seven pedicled (43 reverse and 14 antegrade flow) and 10 free radial forearm flaps were performed in 66 patients, including seven fascial flaps and one osteocutaneous flap. Indications involved soft-tissue coverage of the elbow (n = 11), dorsal wrist and hand (n = 24), palmar wrist and hand (n = 12), and thumb amputations (n = 5); after release of thumb-index finger web space contractures (n = 6) and radioulnar synostosis (n = 2); before toe-to-thumb transfers (n = 3); for reconstruction following tumor excision (n = 13); and for wrapping of the median, ulnar, and radial nerves for traction neuritis (n = 5). RESULTS Primary healing of the soft-tissue defect of the elbow, wrist, and hand was successful in 95 percent of patients. There was one flap dehiscence, partial loss of two reverse radial forearm flaps, and complete loss of one free radial forearm flap. Eleven donor sites were closed primarily and 56 were covered with a split-thickness skin graft. No patients complained specifically of cold intolerance of the hand or dysesthesias in the superficial radial nerve or lateral antebrachial nerve distribution. CONCLUSIONS This is the largest reported series of radial forearm flaps for reconstruction of the upper extremity. The authors believe the antegrade pedicled radial forearm flap is the optimal flap for coverage of defects around the elbow, and the reverse radial forearm flap is the optimal choice for coverage of moderate-sized defects of the wrist and hand.
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Whitaker I, Josty IC, van-Aalst VC, Banis JC, Barker JH. Microvascular Reconstruction of the Upper Extremity. Eur J Trauma Emerg Surg 2007; 33:14-23. [PMID: 26815970 DOI: 10.1007/s00068-007-7022-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 02/04/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Upper extremity composite tissue defects may result from trauma, tumor resection, infection, or congenital malformations. When reconstructing these defects the ultimate objectives are to provide adequate soft tissue protection of vital structures, and to provide optimal functional and esthetic outcomes. The development of clinical microsurgery has added a large number of treatment options to the trauma surgeon's armamentarium - primarily replantation of amputated tissues and transplantation of vascularized tissues from distant donor sites. Since the early 1970s, considerable refinement in microsurgical tools and techniques together with a better understanding of the anatomy and physiology of microcirculatory tissue perfusion led to the introduction of a variety of thin, pliable and versatile-free flap designs. METHODS Sources for this manuscript include a comprehensive literature search using the PUBMED and EMBASE databases along with relevant text books, Selected Readings in Plastic Surgery(®), and personal experiences of upper extremity reconstruction and microsurgery. RESULTS In this manuscript, we describe the primary microsurgical techniques used to reconstruct upper extremity tissue defects and discuss the basis for selecting one technique over another. CONCLUSION Where possible, the best results may be achieved by reattaching the amputated original tissues (microsurgical replantation). In noninfected, uncontaminated traumatic injuries resulting in composite soft tissue defects, Early free flap reconstruction of the upper extremities has important advantages over delayed (72 h-3 months) or late wound closure (3 months-2 years). In recent years, thin, pliable, and versatile fasciocutaneous flaps such as the anterolateral thigh (ALT) and lateral arm (LA) free flaps have been increasingly used with great success to reconstruct the upper extremity. The use of "spare parts" and functional reconstructions using osteomyocutaneous free flaps or toe to thumb transfers complete the armamentarium of the upper limb reconstructive microsurgeon.
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Affiliation(s)
- Iain Whitaker
- Plastic Surgery Research Laboratory, University of Louisville, Louisville, KY, USA.,Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Ian C Josty
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Vera C van-Aalst
- Plastic Surgery Research Laboratory, University of Louisville, Louisville, KY, USA
| | - Joseph C Banis
- Plastic Surgery Research Laboratory, University of Louisville, Louisville, KY, USA
| | - John H Barker
- Plastic Surgery Research Laboratory, University of Louisville, Louisville, KY, USA. .,Plastic Surgery Research Laboratory, University of Louisville, 511 South Floyd Street, 320 MDR Building, Louisville KY, 40202, USA.
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Abstract
The vascularized fibula may be used for long bone reconstruction reliably and successfully. Since its description by Taylor, the fibula flap has evolved to solve a myriad of long bone reconstructive dilemmas. The flap is used routinely for non-unions, postoncologic resections, and congenital defects. It provides faster and more reliable union than nonvascularized grafts. When constructed in a double-barrel configuration, it offers the ability to bear weight. The vascularized fibula can be used to maintain growth by virtue of transferring the physis. The vascularized fibula is thus both the workhorse and thoroughbred in long bone construction.
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Affiliation(s)
- William C Pederson
- The Hand Center of San Antonio, and Department of Orthopaedic Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78240, USA.
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Coban YK, Uzel M, Cetinus E. The use of vascularized phalanx for the first metacarpal bone defect in a mutilating hand injury. Case report. ANN CHIR PLAST ESTH 2006; 51:235-8. [PMID: 16500741 DOI: 10.1016/j.anplas.2005.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2005] [Accepted: 12/09/2005] [Indexed: 11/16/2022]
Abstract
In this case report, the use of middle phalanx of index finger for reconstruction bone defect of the first metacarpal is described. The reasons for this kind of usage and 1-year follow-up of the patient are discussed. During the follow-up, a pseudoarthrosis was observed in the repaired first ray. And this may be considered as a useful complication, when there is stiffness in the carpometacarpal joint. It may be a result of a stiff joint or vice versa.
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Affiliation(s)
- Y K Coban
- Kahramanmaras University, School of Medicine, Plastic Surgery Department, Kahramanmaras, Turkey.
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Akin S, Ozgenel Y, Ozcan M. Osteocutaneous posterior interosseous flap for reconstruction of the metacarpal bone and soft-tissue defects in the hand. Plast Reconstr Surg 2002; 109:982-7. [PMID: 11884821 DOI: 10.1097/00006534-200203000-00028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A vascularized bone segment of the ulna together with a posterior interosseous fasciocutaneous flap is harvested, including a cuff of the extensor pollicis longus muscle. The authors treated five male patients with metacarpal bone and soft-tissue defects of the hand using a distally based island osteocutaneous posterior interosseous flap. Their ages at the time of surgery ranged from 15 to 37 years (mean, 24 years). The bone defects were in the first metacarpal in three cases, the fourth metacarpal in one, and the fifth metacarpal in one. The length of the donated ulna ranged from 3 to 7 cm (mean, 5 cm). The follow-up period ranged from 5 to 92 months (mean, 39 months). All flaps survived completely. The posterior interosseous flap provides thin skin of good texture, together with vascularized bone, for a one-stage reconstruction of the metacarpal bone and soft-tissue defects in the hand.
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Affiliation(s)
- Selçuk Akin
- Department of Plastic and Reconstructive Surgery, Division of Hand Surgery, Medical Faculty of Uludağ University, 16059 Görükle, Bursa, Turkey.
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