Composite anterolateral thigh perforator flaps in the management of complex hand injuries

Meky, Moustafa Sayed Ahmed; Safoury, Y.

doi:10.1177/1753193411427648

Cited by 15 publications

(14 citation statements)

References 17 publications

(33 reference statements)

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“…Free anterolateral thigh (ALT) flap may be a good option for the reconstruction of the large and complex defects of the upper limb. [7,8] Huge skin islands can be elevated from the thigh to close the large defects exposing the tendons, nerves and bones in this region. Free ALT flap is a right versatile flap since it can be harvested with the tendon of tensor fascia lata for a vascularized tendon reconstruction, [9] with the vastus lateralis muscle to fill dead spaces, [10] or with the lateral femoral cutaneous nerve for the neurotization of the transferred skin paddle.…”

Section: Discussionmentioning

confidence: 99%

Versatile Use Of 'The Posterior Interosseous Flap' In The Reconstruction Of Complex Upper Limb Defects

Barin

Çinal

Kara³

et al. 2019

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Reconstruction of the complex upper extremity defects is a challenging procedure for reconstructive surgeons because of the complex anatomical and functional structure of this region. In reconstruction, local and regional flap options involving the composite tissues are restricted. The posterior interosseous flap (PIO) has been presented "in a single study" with a wide variety of uses, and in this study, the versatility of PIO has been tried to be emphasized by its multitude uses as well as its chance at adaptability to each case. Hence, due to this, the objective to highlight the versatile utility of the PIO flap in clinical practice and to present a good option for the reconstruction of complex upper limb defects for various cases have been targeted. METHODS: We used 26 PIO flaps in 25 patients (18 male and seven female patients) with upper limb defects. The main etiological causes were burn contracture, traffic accident, firearm and acute burn injury. Twenty-two flaps were harvested as fasciocutaneous and four flaps as osteo-fasciocutaneous manner, which were applied to the metacarpal defects. In this study, 25 flaps were transferred as pedicled flaps, of which 23 and 2 flaps had reverse and antegrade blood flows, respectively, whereas one flap was used as a free flap. RESULTS: The mean follow-up period was 14 months. All flaps except one, which had partial necrosis and secondary healed, survived completely. All patients were able to gain basic functions for daily routine activities in the late postoperative period. Patients and/ or their parents were satisfied with the postoperative functional and aesthetic improvements. CONCLUSION: Many advantages of the PIO flap make it useful for the reconstruction of upper limb complex defects. It can be versatilely used based on changing its flow direction and enrichment of contents.

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Section: Discussionmentioning

confidence: 99%

Versatile Use Of 'The Posterior Interosseous Flap' In The Reconstruction Of Complex Upper Limb Defects

Barin

Çinal

Kara³

et al. 2019

Ulus Travma Acil Cerrahi Derg

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“…The search continues, however, for the ideal flap that will fit both the functional demands of the hand while limiting donor morbidity. More recent advances, including both local options such as the adipofascial turnover flap (Braga Silva et al, 2012) and free flap options such as the anterolateral thigh flap (Meky and Safoury, 2011) represent attempts to meet these criteria but continue to be limited in its applications and versatility.…”

Section: Introductionmentioning

confidence: 99%

The physiology, microcirculation and clinical application of the shunt-restricted arterialized venous flaps for the reconstruction of digital defects

Lam

Lin

Bell

et al. 2012

J Hand Surg Eur Vol

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Reconstruction of digital defects using the venous flap offer several advantages but remained unpopular owing to levels of venous congestion rates. We performed animal studies to test the hypothesis that an arterio-venous shunt increases pressure for peripheral flap perfusion and decreases venous congestion. Using an abdominal adipofascial flap model in six male Sprague-Dawley rats, microcirculation was modified as follows: type I - arterial flap; type II - flow-through arterio-venous flap (AVF); and type III - shunt-restricted AVF. In type I flaps, blood flow was observed to be unidirectional in both arterioles and venules. In type I flaps, blood flow was observed to be unidirectional in both arterioles and venules. In type II flaps, blood flow oscillated without a dominant direction and came to a standstill. In type III flaps, blood flowed proximally in a reverse direction whereas distally, flow was similar to type I flaps. In a clinical series, 21 patients received a total of 22 shunt-restricted AVFs. All 22 clinical flaps survived; four flaps suffered epidermolysis but recovered without full thickness loss.

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“…In the most severe cases, such as those described by Del Piñal et al (2006), all hand intrinsics are degloved. Debridement of intrinsic muscles in these cases creates a large, dead space in the mid-palm (including the inter-metacarpal spaces); and these patients are best treated with either a free muscle flap (Del Piñal et al, 2006) or a composite anterolateral thigh perforator thigh flap (Meky and Safoury, in press) to obliterate the dead space and to provide a gliding surface for the tendons. The severity of injury in our industrial cases is intermediate between domestic cases and cases described by Del Piñal et al (2006).…”

Section: Discussionmentioning

confidence: 99%

The exploded hand syndrome: a report of five industrial injury cases

Al-Qattan

2012

J Hand Surg Eur Vol

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The term 'exploded hand syndrome' refers to a specific type of crush injury to the hand in which a high compressive force excessively flattens the hand leading to thenar muscle extrusion through burst lacerations. Out of 89 crushed hands seen over a period of seven years, only five had exploded hand syndrome. They were all male industrial workers ranging in age between 24 and 55 years. All patients had thenar muscle extrusion. Other concurrent injuries included fractures/dislocations, compartment syndrome, and ischaemia. All patients were treated by excision of the extruded intrinsic muscles, as well as primary management of concurrent injuries. All patients had functional assessment including: motor power and sensory testing, range of motion of hand joints, and the quick DASH score. Objective testing showed reduced sensibility in the thumb, reduced grip strength (mean 52% of contralateral hand), reduced pinch strength (mean of 27% of contralateral hand), reduced thumb opposition (the mean Kapandji Score was 5 out of 10), and deficits in the range of motion of the metacarpophalangeal and interphalangeal joints of the thumb. The quick DASH score ranged from 11 to 49 and only two patients were able to go back to regular manual work.

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Composite anterolateral thigh perforator flaps in the management of complex hand injuries

Cited by 15 publications

References 17 publications

Versatile Use Of 'The Posterior Interosseous Flap' In The Reconstruction Of Complex Upper Limb Defects

Versatile Use Of 'The Posterior Interosseous Flap' In The Reconstruction Of Complex Upper Limb Defects

The physiology, microcirculation and clinical application of the shunt-restricted arterialized venous flaps for the reconstruction of digital defects

The exploded hand syndrome: a report of five industrial injury cases

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