Multiple-digit resurfacing using a thin latissimus dorsi perforator flap

Kim, Sang Wha; Lee, Ho Jun; Kim, Jeong Tae; Kim, Youn Hwan

doi:10.1016/j.bjps.2013.10.007

Cited by 15 publications

(27 citation statements)

References 29 publications

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“…After removing duplicate entries and applying our inclusion and exclusion criteria, 14 unique articles were included in the final analysis (Table 1) [678910111213141516171819]. …”

Section: Resultsmentioning

confidence: 99%

“…However, such an approach was invariably associated with the related complications of superficial flap necrosis (up to 42%) and scar contractures with limited functional restoration [1516]. Since then, various reconstructive techniques including fascial flaps [17], omental flaps [18], and fasciocutaneous flaps [19] have been reported with the potential to attain both excellent functional and cosmetic outcomes for Tajima 1 to 3 defects. This subgroup of patients has also seen the introduction of various adjuncts including tissue expansion and negative pressure wound therapy (NPWT) to improve the likelihood of achieving successful outcomes.…”

Section: Resultsmentioning

confidence: 99%

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Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity

Tan

Lellouch

et al. 2017

Arch Plast Surg

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BackgroundUpper extremity soft tissue defects with complete circumferential involvement are not common. Coupled with the unique anatomy of the upper extremity, the underlying etiology of such circumferential soft tissue defects represent additional reconstructive challenges that require treatment to be tailored to both the patient and the wound. The aim of this study is to review the various options for soft tissue reconstruction of complete circumferential defects in the upper extremity.MethodsA literature review of PubMed and MEDLINE up to December 2016 was performed. The current study focuses on forearm and arm defects from the level at or proximal to the wrist and were assessed based on Tajima's classification (J Trauma 1974). Data reviewed for analysis included patient demographics, causality, defect size, reconstructive technique(s) employed, and postoperative follow-up and functional outcomes (when available).ResultsIn accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 14 unique articles were identified for a total of 50 patients (mean=28.1 years). Underlying etiologies varied from extensive thermal or electrical burns to high impact trauma leading to degloving or avulsion, crush injuries, or even occur iatrogenically after tumor extirpation or extensive debridement. Treatment options ranged from the application of negative pressure wound dressings to the opposite end of the spectrum in hand transplantation.ConclusionsWith the evolution of reconstructive techniques over time, the extent of functional and aesthetic rehabilitation of these complex upper extremity injuries has also improved. The proposed management algorithm comprehensively addresses the inherent challenges associated with these complex cases.

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“…After removing duplicate entries and applying our inclusion and exclusion criteria, 14 unique articles were included in the final analysis (Table 1) [678910111213141516171819]. …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity

Tan

Lellouch

et al. 2017

Arch Plast Surg

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“…The thoracodorsal artery perforator flap has been reliably used for various reconstruction operations ranging from head and neck reconstruction to hand resurfacing . The thickness of this flap can be safely reduced to about 5 mm.…”

Section: Discussionmentioning

confidence: 99%

“…The thickness of this flap can be safely reduced to about 5 mm. Thinning procedures are easily performed while harvesting the flap using dissection between the deep and superficial fat layers . If more thin flaps are required, defatting procedures are performed after anastomosis, during insetting of the flap, while preserving the perforator vessels entering the flap.…”

Section: Discussionmentioning

confidence: 99%

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Toe resurfacing with a thin thoracodorsal artery perforator flap

Kim

Sung

et al. 2015

Microsurgery

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Multiple digit resurfacing with a lateral thoracic free flap: Two‐stage mitten hand and division procedures

Ryoo

Park

et al. 2023

Microsurgery

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PurposeThe conventional abdominal and groin flaps for resurfacing the defect have several disadvantages, including the risk of flap failure due to accidental traction or detachment, immobilization of the arm before division, and aesthetic dissatisfaction because of the flap bulkiness. The aim of this study was to share our experiences with the free lateral thoracic flap and elucidate the optimal timing of division in complex hand reconstruction, which yielded favorable outcomes in terms of both functionality and aesthetics.MethodsThis article is a retrospective review of multiple digit resurfacing using free tissue transfer from 2012 to 2022. Patients who underwent two‐stage operation including mitten hand creation using superthin thoracodorsal artery perforator (TDAp) free flap and secondary division were included. A flap was elevated over the superficial fascia layer the midportion between the anterior border of the latissimus dorsi and pectoralis major muscles and once the pedicle was found, an outline that matched the defect was created. A process named “pushing with pressure and cutting” was carried out before pedicle ligation until all the superficial fat tissue had been removed except for around the perforator. Two cases (18%) involved defects of the entire fingers reconstructed by TDAp flap with anterolateral thigh flap. Six cases (55%) had a super‐thin TDAp flap only. In two cases (18%), non‐vascularized iliac bone grafting was required for finger lengthening. One case (9%) was resurfaced with a TDAp chimeric flap including a skin paddle with the serratus anterior muscle. The primary outcome was defined as the survival or failure of the flap, while the secondary outcomes associated complications such as infection and partial flap necrosis. A statistical analysis was not performed due to the size of the case series.ResultsAll 13 flaps survived completely without any complications. Flap dimension ranged from 12 cm × 7 cm to 30 cm × 15 cm. Mitten hand duration prior to division was 41.9 days on average which was essential for the optimal result. During the division procedures, there were nine cases of debulking (82%), six cases of split‐thickness skin graft (STSG) (55%), and three cases of Z‐plasty performed on the first web space (27%). The mean follow‐up period was 20.2 months. Mean Disability of the Arm, Shoulder, and Hand (DASH) Questionnaire score was 10.76.ConclusionsWe resurfaced severe soft tissue defects of multiple fingers with thin to super‐thin free flaps, mainly TDAp flaps. Surgeons can restore original hand shape using a two‐stage reconstructive strategy of mitten hand creation and proper division timing to create a 3‐dimensional hand structure, even in severely injured hands with multiple soft tissue defects of the digits.

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Multiple-digit resurfacing using a thin latissimus dorsi perforator flap

Cited by 15 publications

References 29 publications

Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity

Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity

Toe resurfacing with a thin thoracodorsal artery perforator flap

Multiple digit resurfacing with a lateral thoracic free flap: Two‐stage mitten hand and division procedures

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