Free fasciocutaneous flaps for reconstruction of complete circumferential degloving injury of digits

Lin, Chin-Ta; Chen, Shyi‐Gen; Chen, Tim‐Mo; Dai, Niann‐Tzyy; Chang, Stephen S.

doi:10.1002/micr.22064

Cited by 16 publications

(24 citation statements)

References 33 publications

(59 reference statements)

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“…In the textbook on perforator flaps, Schoeller et al wrote a section titled “S‐FAP flap”; however, the flap they described was based on the medial descending branch of the lateral circumflex femoral artery and was not the S‐FAP flap . Hayashi and Maruyama did not differentiate the S‐FAP flap from a flap based on the lateral circumflex femoral artery and lumped them together under the name “anteromedial thigh flap.” Lin et al reported the use of a free anteromedial thigh flap for digital reconstruction; however, the source vessel of the perforator was not described . Their flap designs were similar to ours; however, their flaps could not be classified because detailed anatomic information about the perforators was not provided.…”

Section: Discussionmentioning

confidence: 70%

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Pedicled superficial femoral artery perforator flaps for reconstruction of large groin defects

et al. 2014

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Soft-tissue defects after wide resection of groin sarcomas have been reconstructed with well-characterized flaps, such as rectus abdominis, gracilis, and anterolateral thigh flaps. To our knowledge, the use of superficial femoral artery perforator (S-FAP) flaps for this purpose has not been reported. We report on three female patients in whom groin defects after sarcoma resection were reconstructed with pedicled S-FAP flaps. The dimensions of the skin defects ranged from 13.5 × 11 to 16 × 14.5 cm. Sizable perforators from the superficial femoral arteries were identified preoperatively around the apex of the femoral triangle with computed tomographic angiography or color Doppler ultrasonography. The lengths of the flaps ranged from 17 to 19 cm. The main perforator penetrated the sartorius muscle in two patients and emerged between the sartorius and the adductor longus muscles in the other patient. The postoperative course was uneventful, and results were satisfactory in all patients. The main advantages of the S-FAP flap over more commonly used flaps are that it is easier to harvest and is associated with less donor-site morbidity. We believe that the S-FAP flap may be a versatile option for the coverage of groin defects.

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Section: Discussionmentioning

confidence: 70%

“…11 Lin et al reported the use of a free anteromedial thigh flap for digital reconstruction; however, the source vessel of the perforator was not described. 12 Their flap designs were similar to ours; however, their flaps could not be classified because detailed anatomic information about the perforators was not provided.…”

Section: Discussionmentioning

confidence: 90%

Pedicled superficial femoral artery perforator flaps for reconstruction of large groin defects

et al. 2014

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“…Therefore, we decided to reconstruct with a flap. There are many other flaps for reconstruction of this case including local/distant flaps and free flaps such as medial plantar flap, medialis pedis flap, and venous flap, that we offered as reconstructive options before the treatment . Because the patient desired a concealable donor site with less morbidity, we decided to use a flap from the lower‐abdominal/inguinal region.…”

Section: Discussionmentioning

confidence: 99%

“…There are many other flaps for reconstruction of this case including local/distant flaps and free flaps such as medial plantar flap, medialis pedis flap, and venous flap, that we offered as reconstructive options before the treatment. [10][11][12] Because the patient desired a concealable donor site with less morbidity, we decided to use a flap from the lower-abdominal/inguinal region. SCIP flap and SIEA flap have a long pedicle suitable for various reconstructions, and their donor scars are well-concealable.…”

Section: Discussionmentioning

confidence: 99%

Sensate superficial inferior epigastric artery flap innervated by the iliohypogastric nerve for reconstruction of a finger soft tissue defect

Yamamoto

Koshima

2014

Microsurgery

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In the era of perforator flaps, lower-abdominal/inguinal perforator flaps such as superficial circumflex iliac artery perforator (SCIP) flap and superficial inferior epigastric artery (SIEA) perforator flap are becoming popular with its longer vascular pedicle and usefulness in various reconstructions. SIEA flap's region is innervated by the T12 nerve and the iliohypogastric nerve (IHN), but no sensate SIEA flap has been reported so far. In this report, we present a case in which a sensate SIEA flap innervated by the IHN was used for reconstruction of a finger soft tissue defect. A 55-year-old male suffering from the volar skin necrosis of the right ring finger underwent the volar soft tissue reconstruction using a free sensate SIEA flap because of hypoplastic SCIA. The SIEA flap included the IHN anterior branch, and neuroraphy was performed between the IHN and the third common digital nerve in an end-to-side manner after vascular anastomoses. The reconstructed volar skin could sensate 14 weeks after the surgery. At postoperative 6 months, Semmes-Weinstein test and moving 2-point discrimination revealed 3.64 and 8 mm in the proximal portion of the SIEA flap where the IHN was supposed to innervate. The IHN may be included in a SIEA flap, and a sensate SIEA flap may be a useful option when a SCIP flap is not available. Further anatomical and clinical studies are required to clarify anatomy and clinical usefulness of the IHN.

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“…[2] Among many options of treating a degloving injury are: salvaging the degloved segment through conservative therapy with dressing, debriding and skin grafting, maintaining vascularity by arterial anastomosis or arteriovenous shunting; and coverage by free flaps if the segments are not salvageable. [3][4][5] The traditional approach to the circumferentially degloved segment of problematic flap viability has been to resuture the flap and to wait and see. However, the waiting period or the specific treatment protocol remains uncertain.…”

mentioning

confidence: 99%

Neutrophil Elastase Inhibitor Increases Flap Survival in Experimental Degloving Injuries

et al. 2018

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A vulsion and degloving injuries are caused by a vast array of mechanisms, machines and situations, in which the hand is injured with low energy shearing forces in a rigid position.[1] These types of injuries have generally been viewed as among the most problematic of injuries to manage due to their extensive nature of associated damage. During degloving injuries, blood vessels having great elasticity, are disembodied and separated with irreversible injury along the entire length of involvement and so are the tendons and nerves. Furthermore in circumferential degloving injuries, the distal flap goes through a state of abrupt ischemia followed by reverse perfusion forming after the reattachment of the flaps back to its' origin. Arnez et al, recently reclassified degloving injuries according to the Objectives: Degloving hand injuries have generally been viewed as among the most difficult of injuries to manage due to the extensive nature of associated damage. The traditional approach to the circumferentially degloved segment of problematic flap viability has been to resuture the flap and to wait and see. However, the waiting period or the specific hemorheological protocol remains uncertain. The purpose of this study is to acknowledge if Sivelestat, known to ameliorate ischemia reperfusion injury, enhances the survival of avulsed flaps in a hind limb degloving model of rats and to compare Sivelestat's effects to Pentoxifylline. Methods: Total flap area (cm 2 ), area of necrosis in the flap (cm 2 ), and the ratio between the necrotic and total areas (percentage) were determined. Angiogenesis among the groups were documented with CD31, anti-PECAM stainings. TUNEL assay was performed to allow the visualization of cell nuclei containing fragmented DNA, a typical feature of apoptosis. Results: This study demonstrated that, Sivelestat administered at 10 mg/kg/hour dosage will inhibit the ischemia reperfusion injury more pertinently than Pentoxifylline which exerts only hemorheological effects. Conclusion:The anti-inflammatory effects of Sivelestat, will be beneficial for decreasing the early complications of degloving injury, such as inflammation, sepsis, and edema, better than Pentoxifylline which exerts only hemorheological effects.

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Free fasciocutaneous flaps for reconstruction of complete circumferential degloving injury of digits

Cited by 16 publications

References 33 publications

Pedicled superficial femoral artery perforator flaps for reconstruction of large groin defects

Pedicled superficial femoral artery perforator flaps for reconstruction of large groin defects

Sensate superficial inferior epigastric artery flap innervated by the iliohypogastric nerve for reconstruction of a finger soft tissue defect

Neutrophil Elastase Inhibitor Increases Flap Survival in Experimental Degloving Injuries

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