Reconstruction of Upper Limb Soft Tissue Injuries, Except for Fingertips Lesions

Jelski, Carlos Alberto Eguez; Szendler, Gustavo Baladore; Cavalheiro, Cristina Schmitt; Vieira, Luiz Ângelo; Caetano, Edie Benedito

doi:10.1590/1413-785220212902239180

Acta ortop. bras.

2021

DOI: 10.1590/1413-785220212902239180

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Reconstruction of Upper Limb Soft Tissue Injuries, Except for Fingertips Lesions

Carlos Alberto Eguez Jelski

Gustavo Baladore Szendler

Cristina Schmitt Cavalheiro

et al.

Abstract: Objective: The main purpose of this work was to evaluate the advantages and disadvantages of reconstructive procedures applied in upper limb soft tissue injuries according to their location. Methods: The study involved 94 male and 22 female patients (116 total) operated between April 2001 and November 2017 due to traumatic injuries in a upper limb. Individuals were evaluated considering their age, sex, etiology, reconstruction area , applied methodology and complications. The finger injuries were excluded. … Show more

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Cited by 4 publications

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The Outcomes of the Forearm Flap Applications in the Upper Limb Severe Injuries Reconstruction

KARIM-ZADE¹,

MALIKOV²,

ODINAEV³

et al. 2021

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Objective: Improving the outcomes of surgical treatment of upper limb (UL) injuries by using regional soft tissue flaps. Methods: The analysis of surgical interventions outcomes of integumentary tissue defects and forearm and hand structures of traumatic genesis was conducted in 37 patients. Traumatic injuries to the forearm and hand structures with soft tissue defects occurred in 11 patients, and 26 trauma patients were hospitalized. The patients had superficial soft tissue defects (STDs) involving various areas, accompanied by damage to the underlying neurovascular bundles (NVBs), tendons and bones. Results: Depending on the nature of trauma and the injured tissues’ state, the reconstruction sequence’s principle was followed. In 32 (86.5%) cases, the restoration of functional skin integument and reconstruction of injured anatomical structures of the limb were performed in a single stage. Twostage reconstruction was carried out in 5 (13.5%) patients, with initial STDs repair followed by reconstruction of the NVBs and tendons. Selection criteria for a sequence of surgical repair included the nature of the injury and the severity of the patient’s condition in emergencies. The following grafts were used: RFFF: radial forearm free flap (n=3); RRF: the reverse radial forearm flap (n=25); the ulnar reverse forearm flap (n=6), PIA: posterior interosseous artery flap (n=3). In the immediate postoperative period, compromised blood circulation in the transplanted flaps were observed in 2 (5.4%) cases. Timely diagnosis and treatment resulted in a positive outcome. Long-term functional and aesthetic outcomes of the reconstruction were considered acceptable in all patients. Conclusion: A proper surgical procedure selection for UL structures injuries and their consequences influences long term postoperative aesthetic and functional outcomes. Choice of single or multiple stages of reconstruction largely depends on the location of the defect, the state of the tissues in the recipient area and the nature of the injury to the underlying anatomical structures of the limb. Keywords: Upper limb, injuries and their consequences, soft-tissue defect, flaps.

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The Outcomes of the Forearm Flap Applications in the Upper Limb Severe Injuries Reconstruction

KARIM-ZADE¹,

MALIKOV²,

ODINAEV³

et al. 2021

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Delayed Reconstructive Surgery for Severe Hand Injuries

Malikov¹,

ARTYKOV²,

KARIM-ZADE³

et al. 2022

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Objective: To justify the use of delayed reconstructive interventions in severe complex hand injuries. Methods: The results of delayed reconstructive surgery in 22 patients with a severe complex hand injury for the period from 2010 to 2022 were analyzed. Most of the patients (81.8%) were admitted within 4 to 7 days after injury and received primary care in non-specialized institutions. The age of patients ranged from 17 to 45 years, with the mean age being 28.3 years. They had crush hand injuries with an incomplete avulsion of all fingers (3), II-V fingers (6), II-IV fingers (9), and II-III fingers (1), in three cases, an extensive wound defect of the hand was accompanied by complete amputation of II-III (1) and II-IV fingers (2). The concomitant defect of integumentary tissues had an extended character in case of damage by electric machines (101.2±3.6 cm2) and gunshot wounds (92.1±3.7 cm2). Results: The rationale for the use of delaying tactics was the severity of the injury, the time point of admission, and the decompensation of blood circulation in the fingers in 8 out of 16 admitted patients. All the patients underwent delayed necrosectomy with preservation of the maximum length of viable bone fragments. An extensive defect of the integumentary tissues was covered with a skin-fascial inguinal flap. The second stage performed was one-step directed nerve implantation with phalangization of the transplanted flap (6). For reinnervation, the superficial branch of the radial nerve was most often used as a donor’s nerve. The restoration of sensitivity was registered 3 months after the surgery. Conclusion: As a result of multi-stage complex reconstructive plastic surgery performed on a primary-delayed basis for severe complex hand and fingers injuries, followed by correcting operations to improve the sensory input of the residual segments; the adequate functional outcome was obtained with an improvement in the patient’s quality of life. Keywords: Severe hand injury, hand defects, hand reconstruction, flaps, neurotization.

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Analysis of Complications After Autograft Transplantation in Severe Upper Limb Injury

KARIM-ZADE¹

2023

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Objective: To analyze the complications after transplantation of vascularized autografts in upper limb injuries and develop a set of measures to eliminate them. Methods: Surgical treatment outcomes of 159 patients with severe upper limb injury sequelae were analyzed. The study population comprised 102 (64.1%) males, 57 (35.8%) females, and 49.6% of the patients were under 18. In forearm and hand injuries sequelae, 159 vascularized skin fascia and skin-bone composite autograft flaps were used. Of the 159 grafts, free flaps grafting and pedicled flaps grafting were performed in 30 (18.8%) and 129 (81.2%), respectively. Results: Of 30 free flaps, circulatory compromise was observed in 4 (13.3%) cases in the early postoperative period. Out of the total 159 grafts used, the percentage was 2.5%. In evaluating complications, it was revealed that the flap circulatory compromise of 4 patients was noted in the following grafting types: radial osseocutaneous (1), radial fasciocutaneous (1), fibula transplant (1), and inguinal fasciocutaneous (1). Of the 129 reverse and transposition flaps, a circulatory compromise was noted in 10 (7.7%) cases. Out of the total 159 flaps, the percentage of circulatory compromise was 6.3%. Of the total 159 free and pedicled flaps, necrosis with flap loss was observed in 6.9%. Conclusion: Timely diagnosis of complications based on clinical and axillary investigations data facilitated conducting appropriate conservative measures or surgical revision, which helped to achieve engraftment of transplanted autografts in 93.1% of cases. Keywords: Upper limb injury, injury sequelae, autotransplantation, flap engraftment, flap necrosis.

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Reconstruction of Upper Limb Soft Tissue Injuries, Except for Fingertips Lesions

Cited by 4 publications

References 27 publications

The Outcomes of the Forearm Flap Applications in the Upper Limb Severe Injuries Reconstruction

The Outcomes of the Forearm Flap Applications in the Upper Limb Severe Injuries Reconstruction

Delayed Reconstructive Surgery for Severe Hand Injuries

Analysis of Complications After Autograft Transplantation in Severe Upper Limb Injury

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