Free Vascularized Medial Plantar Flap with Functioning Abductor Hallucis Transfer for Reconstruction of Thenar Defects

Ibaraki, Kunio; Kanaya, Fuminori

doi:10.1097/00006534-199501000-00017

Cited by 24 publications

(13 citation statements)

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“…In addition, thenar defects of the hand have also been restored functionally using the free medial plantar flap with a functioning abductor hallucis transfer. 9 We harvested the flap the same size as the defect because marked primary contraction of the flap did not occur as a result of its unique fibrofatty structure. We were obliged to discard the excess tissue in the case of raising the flap larger than the defect.…”

Section: Discussionmentioning

confidence: 99%

Various Applications of the Medial Plantar Flap to Cover the Defects of the Plantar Foot, Posterior Heel, and Ankle

Açıkel

Çeli̇köz

Yüksel

et al. 2003

Annals of Plastic Surgery

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The medial plantar fasciocutaneous flap provides structurally similar tissue to plantar foot, posterior heel, and ankle defects with its thick glabrous plantar skin, shock-absorbing fibrofatty subcutaneous tissue, and plantar fascia. During the past 4 years, 24 patients (20 men, 4 women) with skin and soft-tissue defects over the plantar foot, posterior heel, or ankle were treated. They ranged in age from 20 to 42 years (mean, 24 y). The medial plantar flap was transposed to the defects in four different ways: proximally pedicled sensorial island flaps (N = 18), reverse-flow island flaps (N = 2), free flaps (N = 2), and cross-foot flaps (N = 2). Flap size varied from a width of 2 to 5.5 cm and a length of 5 to 7.5 cm. The follow-up period ranged from 2 to 18 months (mean, 9 mo). Partial flap loss was observed in one free flap and one reverse-flow island flap. Partial skin graft lost in the donor site required regrafting in one patient. Durable, sensate coverage of the defects was achieved in all patients.

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Section: Discussionmentioning

confidence: 99%

Various Applications of the Medial Plantar Flap to Cover the Defects of the Plantar Foot, Posterior Heel, and Ankle

Açıkel

Çeli̇köz

Yüksel

et al. 2003

Annals of Plastic Surgery

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“… 10 There have been some novel descriptions for thumb opposition reconstruction in the literature. 1 , 4 , 5 , 9 , 11 , 12 The serratus anterior muscle has also been well described and has favorable anatomy for being a donor muscle used in FFMT. Logan et al 7 outlined the benefits of this muscle, including, the relatively easy harvest, long reliable vascular pedicle, thin and easily contoured slips that could be separated, and the ability to dynamically reinnervate this muscle.…”

Section: Discussionmentioning

confidence: 99%

Free Functional Muscle Transfer for Thumb Opposition

Seal

Stevanović

2018

Plastic and Reconstructive Surgery - Global Open

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Summary:Traumatic injuries and other conditions resulting in thenar loss and loss of opposition function can cause significant functional limitations. There are limited options available to restore function and bulk to the thenar musculature. A 26-year-old man had an unfortunate accident at work with a machine mixer creating a crush injury to his left hand. This required several debridements due to the tissue injury and resulted in loss of the thenar muscles and ability to oppose the thumb. He recovered well from the initial injury, however, was left with difficulty with grasp and holding objects due to the loss of thenar motion and strength. His function was also affected by the loss of bulk. He successfully underwent a free functional muscle reconstruction with his serratus anterior. This case report is a description of his reconstruction and a review of the literature. The patient had an excellent outcome. He obtained active opposition and improved grip strength, improving his activities of daily living and vocational life. The serratus anterior muscle can successfully be used for thumb opposition reconstruction. This case report demonstrates good outcomes for both motion and bulk restoration.

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“…Dissection of the donor was also difficult. The free medial plantar flap combined with the abductor hallucis muscle may provide a strong muscle transfer with an additional skin coverage 16, 17. However, harvesting of the donor nerve was complicated, and the limited length of the vascular pedicle frequently required the posterior tibial artery to be included in the transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…When there is extensive damage in the thenar region with loss of thenar muscles, the microsurgical free functional muscle transplantation has provided a useful solution. The muscle flaps included the extensor digitorum brevis (EDB) muscle from the foot,14, 15 the abductor hallucis muscle and medial plantar skin flap,16, 17 and the gracilis muscle from previous reports 18. However, experience is limited, and these techniques have raised concern about donor site morbidity, limitation of the length of the neurovascular pedicle, and difficulty of dissection.…”

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confidence: 99%

Functional pectoralis minor muscle flap transplantation for reconstruction of thumb opposition: An anatomic study and clinical applications

Zhuang

Xiong

et al. 2011

Microsurgery

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In this report, we present the results of an anatomic study on the dimensions of the pectoralis minor muscle and its neurovascular supply in 10 adult human cadavers, in attempt to evaluate the feasibility of microsurgical transplantation of a part of the muscle for thumb opposition reconstruction. A series of five patients consequently underwent thenar reconstruction with the pectoralis minor muscle flap from December 2004 to October 2006. The transferred muscle was reinnervated with the third lumbrical branch of the ulnar nerve. Follow-up assessment showed that the patients recovered functional opposition of carpometacarpal joint with 24 degrees of pronation, and a muscle power with M4 to M5. All patients were satisfied with the appearance of reconstructed thenar eminence. We recommend this new technique for thenar and opposition reconstruction in patients who have severe loss of thenar muscles, injury to the median nerve, and wish to improve the appearance of thenar eminence.

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Free Vascularized Medial Plantar Flap with Functioning Abductor Hallucis Transfer for Reconstruction of Thenar Defects

Cited by 24 publications

References 0 publications

Various Applications of the Medial Plantar Flap to Cover the Defects of the Plantar Foot, Posterior Heel, and Ankle

Various Applications of the Medial Plantar Flap to Cover the Defects of the Plantar Foot, Posterior Heel, and Ankle

Free Functional Muscle Transfer for Thumb Opposition

Functional pectoralis minor muscle flap transplantation for reconstruction of thumb opposition: An anatomic study and clinical applications

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