Dorsal Metacarpal Artery Flap for Resurfacing of Fourth-Degree Electrical Burns of Fingers

Karunadasa, Kolitha P.; Beneragama, Thushan; Dissanayake, Dammika; Perera, Dulip

doi:10.1097/bcr.0b013e3181e4c57b

Cited by 3 publications

(1 citation statement)

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“…4 The disadvantages of these conventional flaps include syndactyly, bulkiness of the flap, subsequent flap thinning, unacceptable functional and aesthetic outcome, and long-term hospitalization. 5,6 Recently, there was a report on using a pocket flap-graft to cover the defect of acute burned hands without 2-stage syndactyly release procedure. 7 Nevertheless, there have been very few reports on using this flap to attempt the repair of the exposed dense connective tissues (DCT) in severely burnt hands or with infections.…”

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confidence: 99%

Superthin Abdominal Wall Glove-Like Flap Combined With Vacuum-Assisted Closure Therapy for Soft Tissue Reconstruction in Severely Burned Hands or With Infection

Wang

Liu

Qiu

et al. 2015

Annals of Plastic Surgery

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Severe burn and infection to hands always involves the deep structures, such as tendons, joints, and bones. These wounds cannot be closed immediately and therefore creates a high risk for complication. We presented 9 cases with deep dermal burns to the dorsal of the hand (6 electrical burns and 3 thermal crush injuries) with wound infections in 2 cases. The vacuum-assisted closure system was used continuously until the flap reconstruction was performed. A random pattern and superthin abdominal wall skin flap-like glove was designed. The flap was transferred to the defected portion of the dorsum of the hand and resected from the abdominal wall about 3 weeks later. The flaps in 8 of the patients treated by this technique survived completely and partial necrosis of the distal flap occurred in 1 patient. The defect resolved after operative treatment and the function of the hands and fingers were successfully salvaged. All patients resulted in having a satisfactory aesthetic outcome with no or minor discomfort at the abdominal donor area. Integration of the vacuum-assisted closure system and the superthin abdominal wall glove-like flap reconstruction appeared to be successful and should be considered in patients with severely burned hands. D espite increasing awareness and precautionary measures of thermal injuries, the incidence of hand burns is still high, up to 80% of the treated burn injuries. 1 Serious burn injuries to the hands, comprising nearly 5% of all hand injuries admitted to burns centers, involve structures under the skin such as tendons, joints, or bones. 2 Skin flap reconstruction is an important option for the repair of wounds that have exposed structures underneath the skin. 3 Maintaining the function and integrity of these structures, as well as reconstruction of soft tissues, remains challenging to a surgeon.Several types of flaps have been widely used in coverage of the burned hand including random-pattern abdomen local fasciocutaneous flap, superficial inferior epigastric artery flap, or groin flap. 4 The disadvantages of these conventional flaps include syndactyly, bulkiness of the flap, subsequent flap thinning, unacceptable functional and aesthetic outcome, and long-term hospitalization. 5,6 Recently, there was a report on using a pocket flap-graft to cover the defect of acute burned hands without 2-stage syndactyly release procedure. 7 Nevertheless, there have been very few reports on using this flap to attempt the repair of the exposed dense connective tissues (DCT) in severely burnt hands or with infections.The commercial vacuum-assisted closure (VAC) dressing is a recently developed tool that has several clinical applications in burn and trauma care. It has successfully achieved the effective outcomes, especially in the complex field of wound management such as traumatic injury, infected surgical wound, and DCT exposure. [8][9][10] To obtain more satisfactory functional and cosmetic restoration for severely burnt hands or with infection, we herein present our experience on the use of super...

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confidence: 99%