Approach to Complex Upper Extremity Injury: An Algorithm

Ng, Zhi Yang; Askari, Morad; Chim, Harvey

doi:10.1055/s-0035-1544165

Cited by 25 publications

(9 citation statements)

References 26 publications

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“…Principles of upper limb trauma management in general, have been reported by other authors. 7 , 38 The overall complication rate in our series was 31.4%. However, 11.4% required surgical intervention for optimization, rest of them were minor complications and managed expectantly.…”

Section: Discussionmentioning

confidence: 48%

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Reconstruction of post-traumatic upper extremity soft tissue defects with pedicled flaps: An algorithmic approach to clinical decision making

Naalla

Chauhan

Dave

et al. 2018

Chinese Journal of Traumatology

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PurposePedicled flaps are still the workhorse flaps for reconstruction of upper limb soft tissue defects in many centers across the world. They are lifeboat options for coverage in vessel deplete wounds. In spite of their popularity existing algorithms are limited to a particular region of upper limb; a general algorithm involving entire upper limb which helps in clinical decision making is lacking. We attempt to propose one for the day to day clinical practice.MethodsA retrospective analysis of patients who underwent pedicled flaps for coverage of post-traumatic upper extremity (arm, elbow, forearm, wrist & hand) soft tissue defects within the period of January 2016 to October 2017 was performed. Patients were divided into groups according to the anatomical location of the defects. The flaps performed for different anatomical regions were enlisted. Demographic data and complications were recorded. An algorithm was proposed based on our experience, with a particular emphasis made to approach to clinical decision making.ResultsTwo hundred and twelve patients were included in the study. Mean age was 27.3 years (range: 1–80 years), 180 were male, and 32 were female. Overall flap success rate was 98%, the following complications were noted marginal flap necrosis requiring no additional procedure other than local wound care in 32 patients (15%), partial flap necrosis requiring flap advancement or extra flap in 15 patients (7%), surgical site infection in 11 patients (5%), flap dehiscence requiring re-suturing in 5 patients (2.4%), total flap necrosis 4 patients (2%).ConclusionThe proposed algorithm allows a reliable and consistent method for addressing diverse soft tissue defects in the upper limb with high success rate.

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Section: Discussionmentioning

confidence: 48%

“…The reconstructive algorithms exist for specific regions of upper limb 5 , 6 or general management of upper limb trauma. 7 , 8 A general algorithm encompassing the whole of upper limb reconstruction with pedicle flaps is helpful in day to day practice.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of post-traumatic upper extremity soft tissue defects with pedicled flaps: An algorithmic approach to clinical decision making

Naalla

Chauhan

Dave

et al. 2018

Chinese Journal of Traumatology

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“…Reconstruction is based on established principles. 5,6 Initially, radical debridement of all devitalized and nonviable tissues (including revision amputations as necessary) is performed and revascularization of the hand is performed if required. Subsequently, bony stability is achieved through open reduction and internal fixation or pinning of axial carpal dissociations and/or carpometacarpal joint (CMCJ) dislocations to restore anatomical alignment to the carpus as much as possible.…”

Section: Treatment Protocolmentioning

confidence: 99%

Patterns of Complex Carpal Injuries in the Hand from Fireworks

Shamrock

Chen

et al. 2018

J Hand Microsurg

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To describe the various patterns of complex carpal and metacarpal fracture dislocations observed in a consecutive series of firework injuries and the operative management performed. We performed a retrospective study of seven consecutive patients (six males; mean age = 22 ± 13, range, 8-39 years) who presented to a level I trauma center with firework injuries to the hand between July 2014 and January 2016. All injuries were sustained while a lighted firework was held in the hand. The mean length of hospital stay was 13.9 ± 13.8 (range, 4-46) days with an average of 3 ± 2.6 (range, 1-7) surgeries required for both bony and soft tissue reconstruction. Three patterns of injury were seen: type I-no carpal involvement; type II-carpometacarpal joint (CMCJ) dislocations and isolated carpal dislocations; type III-CMCJ dislocations with axial carpal dissociation. One patient had a type I injury, three had a type II injury, and three had a type III injury. Of patients with a type III injury, two of the three had simultaneous axial-radial and axial-ulnar involvement as well as a midcarpal dissociation with divergent dissociation of the carpus and metacarpals. The severity of carpal injuries resulting from fireworks is highly variable but is likely to follow predictable patterns due to the position of the hand and the location of the firework prior to explosion. Surgical reconstruction can be challenging, but adequate outcomes with a functional hand can be achieved through a systematic approach. Therapeutic level IV.

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“…Management of these complex defects in the acute setting is based on established principles and is detailed elsewhere [20]. …”

Section: Discussionmentioning

confidence: 99%

Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity

Tan

Lellouch

et al. 2017

Arch Plast Surg

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BackgroundUpper extremity soft tissue defects with complete circumferential involvement are not common. Coupled with the unique anatomy of the upper extremity, the underlying etiology of such circumferential soft tissue defects represent additional reconstructive challenges that require treatment to be tailored to both the patient and the wound. The aim of this study is to review the various options for soft tissue reconstruction of complete circumferential defects in the upper extremity.MethodsA literature review of PubMed and MEDLINE up to December 2016 was performed. The current study focuses on forearm and arm defects from the level at or proximal to the wrist and were assessed based on Tajima's classification (J Trauma 1974). Data reviewed for analysis included patient demographics, causality, defect size, reconstructive technique(s) employed, and postoperative follow-up and functional outcomes (when available).ResultsIn accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 14 unique articles were identified for a total of 50 patients (mean=28.1 years). Underlying etiologies varied from extensive thermal or electrical burns to high impact trauma leading to degloving or avulsion, crush injuries, or even occur iatrogenically after tumor extirpation or extensive debridement. Treatment options ranged from the application of negative pressure wound dressings to the opposite end of the spectrum in hand transplantation.ConclusionsWith the evolution of reconstructive techniques over time, the extent of functional and aesthetic rehabilitation of these complex upper extremity injuries has also improved. The proposed management algorithm comprehensively addresses the inherent challenges associated with these complex cases.

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Approach to Complex Upper Extremity Injury: An Algorithm

Cited by 25 publications

References 26 publications

Reconstruction of post-traumatic upper extremity soft tissue defects with pedicled flaps: An algorithmic approach to clinical decision making

Reconstruction of post-traumatic upper extremity soft tissue defects with pedicled flaps: An algorithmic approach to clinical decision making

Patterns of Complex Carpal Injuries in the Hand from Fireworks

Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity

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