The authors present 20 microvascular flaps based on arteriovenous perfusion, harvested from the distal anterior forearm, and configured in three different designs. Indications were small palmar, dorsal, and commissural defects, when other conventional procedures were not available; problematic cases of open reduction internal fixation with skin defect; and when aggressive rehabilitation was needed. The follow-up varied between 6 and 28 months. Some degree of vascular congestion was observed in 100 percent of the flaps, and those changes were classified in a progressive form. Coverage was judged as stable, thin, and pliable in 75 percent of the cases in the series; aggressive rehabilitation was started promptly in all cases where this was possible. On average, an additional 2.4 hr were required for the original procedure. This flap demands little technical expertise for any microsurgical surgeon, and does not sacrifice any important donor vessel. The flap should not be followed-up by conventional monitoring methods instead, simple palpation of the pulse, Doppler auscultation, or PPG are required.
Summary: A significant proportion of high-flow arteriovenous malformations (AVMs) in the hand are complex to treat due to their multicentricity, size, and risk of jeopardizing distal circulation. Therefore, AVMs are frequently considered “inoperable.” We present the case of a multifocal recurrent AVM treated in conjunction with the interventional radiology department, with intra-arterial embolization and excision followed by immediate distal revascularization to replace the resulting arterial deficit. This is a case of a 24-year-old woman with a high-flow multifocal AVM in her right hand, partially excised 2 years ago, showing a pulsatile mass in the palm and dorsum of the right hand, and a reporting pain of 8 of 10 on the visual analogue scale. The procedure was performed in our hybrid operating room. This procedure lasted 4 hours, with intraoperative bleeding of 75 mL. Three weeks after the procedure, patency and good circulation of the three revascularized fingers was demonstrated using arteriography and no evidence of vascular anomalies were found. No skin loss occurred, and no reintervention was required. For radical excision of this complex high-flow recurrent AVM, detailed intraoperative documentation of its afferent and immediate embolization with gelatin-based hemostatic agents allowed its obliteration with a low reactive material. We consider that this approach might be an option to treat AVMs that are currently considered inoperable.
Tendon lacerations are commonly presented in hand injuries. Within flexor tendons, zone 5 has not been a spotlight topic in the literature although it encompasses important tendons involved in wrist stability. The aim of the study was to highlight the importance of tendon repair in flexor zone 5 introducing a novel technique. In this article we described our new surgical technique use at the plastic and reconstructive surgery unit of the General Hospital of Mexico with 4 different flexor tendon zone 5 injuries. All cases included a HBRT laceration in this zone. We also describe its variances for reconstruction based on our proposed tendon territory classification. Our tendon injury classification is based on anatomical features and may be useful for repair planning. Our technique is based on a ‘like with like’ tendon supply to achieve a strong biomechanical reinforcement. TGW technique was a reliable reinforcement on primary tendon repair after using a conventional tenorrhaphy. Tendon reconstruction still has a field of research and improvements. Our work stands out some specific tendon requirements and relevant territories. We propose a simple management with a novel technique.
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