Combined medialis pedis and medial plantar fasciocutaneous flaps based on the medial plantar pedicle for reconstruction of complex soft tissue defects in the hand

Chai, Yimin; Wang, Chunyang; Wen, Gen; Zeng, Bingfang; Cai, Ping; Han, Pei

doi:10.1002/micr.20817

Cited by 24 publications

(24 citation statements)

References 25 publications

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“…As far as we know, this report is the first to describe combined medialis pedis and medial plantar fasciocutaneous flaps for restoration of range of motion in adjacent injured fingers. Combined medialis pedis and medial plantar fasciocutaneous flaps can cover separated skin defects independently . The medialis pedis flap is nourished by the medial branch of the medial plantar artery, and the medial plantar flap is nourished by the lateral branch of the medial plantar artery.…”

Section: Discussionmentioning

confidence: 99%

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Combined medialis pedis and medial plantar fasciocutaneous flaps for coverage of soft tissue defects of multiple adjacent fingers

et al. 2014

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Soft tissue defects of adjacent multiple fingers covered by a single large flap require secondary separation of the flap into each finger. Such covering obstructs independent motion of injured fingers until the single large flap is separated. This report describes the technique of combined medialis pedis and medial plantar fasciocutaneous flaps for reconstructing soft tissue defects of multiple adjacent fingers. Three male patients (age range, 18-33 years) underwent soft tissue reconstructions of multiple adjacent fingers with combined flaps. Injuries involved three adjacent palmar fingers, two adjacent palmar fingers, and two adjacent dorsal fingers. Average sizes of the combined flaps were 4.2 × 4.0 cm for the medialis pedis flap and 3.0 × 1.8 cm for the medial plantar fasciocutaneous flap. All flaps survived without vascular complications, and donor sites healed uneventfully. All patients experienced excellent recovery of range of motion for the reconstructed fingers. In conclusion, combined flaps may offer an alternative for coverage of soft tissue defects that involve multiple adjacent fingers.

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Section: Discussionmentioning

confidence: 99%

“…Combined medialis pedis and medial plantar fasciocutaneous flaps are nourished by different branches via a common vascular pedicle, enabling adjacent soft tissue defects to be covered separately . Moreover, the combined flaps have a skin texture similar to that of the fingers.…”

mentioning

confidence: 99%

Combined medialis pedis and medial plantar fasciocutaneous flaps for coverage of soft tissue defects of multiple adjacent fingers

et al. 2014

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“…The island flaps, such as the posterior interosseous artery flap (also known as the island forearm flap), have also been used to repair soft tissue defect wounds of the fingers . However, the size and the length of the vessel pedicle of this type of flaps limit its clinical application for multifinger defect wounds.…”

Section: Discussionmentioning

confidence: 99%

“…The development of microsurgery has greatly boosted the application of various free flaps and venous flaps for the repair of finger wounds, especially when pedicle flaps are unable to cover the large defect . Although the dorsalis pedis flap has been reported to resurface these wounds, producing large free flaps that are suitable for a single large wound on the hand . These free flaps are not the favorable options for coverage of multifinger soft tissue defect.…”

Section: Discussionmentioning

confidence: 99%

The free triple chimeric dorsalis pedis flaps for repair of multifinger soft tissue defects: A report of two cases

Xie¹,

Hu²,

Miao³

et al. 2013

Microsurgery

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The reconstruction of complex hand injury such as multifinger soft tissue defect remains a challenging problem. Two cases of repair of multifinger injury with exposed bones using the free chimeric flaps based on the dorsalis pedis vessels are presented. Two male patients, 46 years old and 36 years old, suffered from a thermocompression injury to the dorsum of fingers resulting in soft tissue defects of multiple fingers. The chimeric free flap was designed and applied to cover the defects. The donor sites were covered by skin grafts. The postoperative courses were uneventful. Both patients were followed up for 10-12 months. The maximal flexion angle of the distal interphalangeal, proximal interphalangeal, and metacarpophalangeal joints were 40°-85° at the end of the follow-up. The protective sensation was achieved on the dorsal fingers. The report suggests that the free chimeric flaps based on the dorsalis pedis artery may be an alternative for the reconstruction of the multifinger dorsal soft tissue defects.

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“…A combined medial plantar artery flap and medialis pedis flap is another alternative for the treatment of multiple smaller palmar defects. 21 Postoperative reports on critical sensation following the coverage of palmar defects with this flap have been encouraging and require further observation. 12,22 However, donor site morbidity of the plantar foot has to be taken into consideration critically especially in laborers.…”

Section: Anatomical Resurfacing Of the Palmmentioning

confidence: 97%

Functional resurfacing of the palm: Flap selection based on defect analysis

et al. 2011

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Extensive defect coverage of the palm and anatomical reconstruction of its unique functional capacity remains difficult. In manual laborers, reconstruction of sensation, range of motion, grip strength but also mechanical stability is required. Sensate musculo-/fasciocutaneous flaps bear disadvantages of tissue mobility with shifting/bulkiness under stress. Thin muscle and fascial flaps show adherence but preclude sensory nerve coaptation. The purpose of this review is to present our algorithm for reliable selection of the most appropriate procedure based on defect analysis. Defect analysis focusing on units of tactile gnosis provides information to weigh needs for sensation or soft tissue stability. We distinguish radial unit (r)-thenar, ulnar unit (u)-hypothenar and unit (c)-central plus distal palm. Individual parameters need similar consideration to choose adequate treatment. Unit (r) and unit (u) are regions of secondary touch demanding protective sensation. Restoration of sensation using neurovascular, fasciocutaneous flaps is recommended. In unit (c), tactile gnosis is of less, mechanical resistance of greater value. Reconstruction of soft tissue resistance is suggested first in this unit. In laborers, free fascial- or muscle flaps with plantar instep skin grafts may achieve near to anatomical reconstruction with minimal sensation. Combined defects involving unit (c) require correlation with individual parameters for optimal flap selection. Defect coverage of the palm should not consist of merely providing sensate vascularized tissue. The most appropriate procedure should be derived from careful defect analysis to achieve near to anatomical reconstruction. In laborers, defect related demands need close correlation with sensation and mechanical stability to be expected.

show abstract

Combined medialis pedis and medial plantar fasciocutaneous flaps based on the medial plantar pedicle for reconstruction of complex soft tissue defects in the hand

Cited by 24 publications

References 25 publications

Combined medialis pedis and medial plantar fasciocutaneous flaps for coverage of soft tissue defects of multiple adjacent fingers

Combined medialis pedis and medial plantar fasciocutaneous flaps for coverage of soft tissue defects of multiple adjacent fingers

The free triple chimeric dorsalis pedis flaps for repair of multifinger soft tissue defects: A report of two cases

Functional resurfacing of the palm: Flap selection based on defect analysis

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