Neo-digit functional reconstruction of mutilating hand injury using transplantation of multiple composite tissue flaps

Li, Xiucun; Cui, Jianli; Maharjan, Suraj; Yu, Xin; Lu, Laijin; Gong, Xu

doi:10.1097/md.0000000000004179

Cited by 8 publications

(5 citation statements)

References 30 publications

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“…Reconstruction during the subacute stages was associated with a lower infection rate and other flap-related adverse events, allowing frequent debridement. The presence of fresh granulation tissue may indicate the optimal time for reconstruction, typically 2 to 3 days after the insult [ 12 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Role of microsurgical free flap reconstruction in managing complex wound: a retrospective cross-sectional study

Altam¹,

Alsaaidi²,

Aljbri³

et al. 2022

Pan Afr Med J

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Introduction while reconstruction of complex wounds with severe tissue defects has been a significant problem in plastic surgery, free flap microsurgical procedures could solve many of these problems. In Yemen, data regarding free flap microsurgery for complex wounds are scarce. This study aimed to share our microsurgery experiences in repairing complex wounds using different free flaps in a resource-limited setting. Methods a retrospective cross-sectional study between April 2019 and June 2022 conducted at 21 University-affiliated hospitals included 30 patients with complex wound defects that were not amenable for regional, pedicle procedures, or skin grafts and underwent microsurgical reconstructions with deferent free flap tissue transfer. The primary outcome was flap survival or failure, while the secondary outcome was postoperative complications. Results the main age was 34.76 ± 16.88 years, with 24 (80%) males and 6 (20%) females. Replacing extensive tissue loss caused by road traffic accidents was the most common indication (36.6%). The mean defects required to be reconstructed were 84.9 ± 44.70 cm 2 . The lower extremities accounted for the majority of reconstructed defects (50%), and mostly (23.3%) involved the leg. Only 10 (33.3%) flaps were performed immediately within 48 hours of trauma. The fibulae osteo-cutaneous free flap (30.0%), radial forearms free flap (23.3%), and anterolateral thigh flap (23.3%) were used most commonly. All flaps were harvested and repaired under loupe magnification or operative microscope by a single surgeon. The overall flap success rate was 83.3%. The total complication rate was 23.3%, and postoperative infection and partial flap necrosis occurred in 3 (10.0%) and 2 (6.6%) patients, respectively. A total flap loss occurred in 5 (16.7%) patients. Conclusion reconstruction of complex wounds with microsurgical free flaps is a viable option even in a resource-limited setting. In our study, microsurgery with fibulae osteo-cutaneous free flap was the most commonly used. Despite many limitations, microsurgical free flaps were effective in treating individuals operated on in our setup with a limb salvage rate of 83.3%.

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Section: Discussionmentioning

confidence: 99%

Role of microsurgical free flap reconstruction in managing complex wound: a retrospective cross-sectional study

Altam¹,

Alsaaidi²,

Aljbri³

et al. 2022

Pan Afr Med J

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“…Recent series indicate that soft tissue reconstruction can produce quite functional fingers with good quality of life. 2…”

Section: Discussionmentioning

confidence: 99%

“…Finger reconstruction after trauma using composite tissue flaps can have good long-term results, with some series reporting 40 degrees motion in the metacarpophalangeal joint and over 70 degrees of motion in the interphalangeal joints. 2 In this case report, we describe a small finger osteocutaneous fillet flap based on the ulnar digital artery used to reconstruct a bony and soft tissue deficit at the level of the adjacent ring finger proximal phalanx.…”

mentioning

confidence: 99%

Small Finger Osteocutaneous Fillet Flap for Reconstruction in Ring Finger Trauma

Parent

Camison

Barreiro

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Summary:Finger amputations are common injuries which result in significant long-term morbidity and loss of function. In this report, we describe a creative operative solution for a 21-year-old man who was in a motorcycle crash and sustained severely comminuted open fractures of the left small and ring fingers with severe crush injury and soft tissue avulsion. Of the tissues and bones in the small finger, only the distal half of the proximal phalanx remained intact and was vascularized via the remaining ulnar neurovascular bundle. In the ring finger, the extensor mechanism and ulnar neurovascular bundle were avulsed and the distal half of the proximal phalanx was absent, but the flexor tendons were intact. A small finger ray amputation was performed. Then, using an osteocutaneous fillet flap based on the ulnar neurovascular bundle from the small finger, the bony gap and soft tissue deficits in the ring finger were reconstructed. The ring finger extensor tendon was then reconstructed. Subsequently, the patient had evidence of bony union on follow-up X-rays and he had a sensate filet flap over the ulnar aspect of the ring finger. This case demonstrates the creative use of a “spare-parts” osteocutaneous fillet flap in the reconstruction of a traumatic finger injury. This example highlights the importance of assessing all available reconstructive options to avoid the morbidity of a finger amputation.

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“…Para minimizar el daño funcional o incluso una amputación tardía, en los casos de lesiones de mano es indispensable implementar una estrategia terapéutica adecuada, para lo cual siempre se debe determinar el tamaño del daño, la futura necesidad de cobertura cutánea y la afectación de la funcionalidad 2-6. Así mismo, es indispensable tener presente que la opción de tratamiento escogida en primera instancia es crucial, ya que esta definirá el futuro de la zona lesionada y determinará la viabilidad de futuros procedimientos 3 .…”

Section: Introductionunclassified

Transferencia de falange para la creación de un dedo bifalángico

Cayón-Cayón¹,

Alegría-Velasco²,

Ramírez-Navarrete³

2022

Cir. Mano Microcir

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Las manos son órganos especialmente vulnerables a lesiones traumáticas, siendo los dedos la zona lesionada con mayor frecuencia, especialmente en el campo laboral; lo anterior conlleva graves complicaciones y consecuencias tanto para el paciente por las limitaciones que ocasiona, como para el sistema de salud por los gastos que genera. Existen varias técnicas para el manejo de lesiones severas en los dedos, pero todas buscan mantener su longitud y funcionalidad. De esta forma, la transferencia pediculada de falange distal hacia la posición de falange media es una alternativa para la creación de un dedo de dos falanges. En el presente estudio se presenta la experiencia clínica y quirúrgica de los autores con el uso de esta técnica en el manejo de lesiones severas sobre la falange media; esta es una técnica que se diseñó con el objetivo de mantener la mayor cantidad de tejido viable posible y una alta funcionalidad de la mano. Con la técnica descrita se observan resultados funcionales y estéticos buenos a corto y mediano plazo, por lo que puede considerarse como una opción válida para el tratamiento de lesiones de las falanges en las que el extremo distal es aún viable.

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Neo-digit functional reconstruction of mutilating hand injury using transplantation of multiple composite tissue flaps

Abstract: Supplemental Digital Content is available in the text

Cited by 8 publications

References 30 publications

Role of microsurgical free flap reconstruction in managing complex wound: a retrospective cross-sectional study

Role of microsurgical free flap reconstruction in managing complex wound: a retrospective cross-sectional study

Small Finger Osteocutaneous Fillet Flap for Reconstruction in Ring Finger Trauma

Transferencia de falange para la creación de un dedo bifalángico

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