Pedicled Abdominal Flaps for Hand Reconstruction in Adults: Physiotherapy of the Attached Hand

Abstract

Background: Hand reconstruction using pedicled abdominal flaps has several disadvantages, including delayed hand therapy leading to stiffness. Methods: This is a retrospective study of 70 cases of pedicled abdominal flaps used for hand reconstruction in adults in whom physiotherapy of the attached hand was implemented. The review aims to investigate the rate of flap dehiscence, infection, hematoma, and flap edge necrosis in our cases, and to establish that physiotherapy of the attached hand is not associated with an increased risk of complications. The review also aims to establish the effectiveness of physiotherapy of the attached hand in reducing the risk of stiffness by documenting the range of motion of the uninjured digits immediately after flap division and at final follow-up. Results: There were no cases of flap dehiscence, infection, or hematoma. Six cases had minor partial flap edge necrosis that was treated conservatively and allowed to heal by secondary intention. In 62 patients, the range of motion of the uninjured digits was 90%–100% of the normal range of motion at day 1 post-flap division, and all of these patients recovered a full range of motion (in the uninjured digits) within 2 weeks of follow-up. Eight patients were reluctant to do the exercises as instructed because of low pain threshold; 4 of these 8 patients had residual stiffness at the final follow-up. Conclusion: The implementation of active exercises of the attached hand is feasible in selected cases and it helps minimize the risk of stiffness of the hand.

Pedicled abdominal skin flap technique for fingers salvaging and reconstruction in a complex palmar hand burn injury: A case report

“…According to the paper by Al-Qattan, in selected cases of pedicled abdominal flap reconstruction, implementing active exercises for the attached hand is feasible, safe, and helps minimize the risk of hand stiffness. The results presented showed favorable outcomes [ 10 ]. The difference is that there have been no reported cases that specifically address the separation of the abdominal flap in the fingers, as in this study.…”

Comparison of Hybrid Abdominal Flap versus Homodigital Neurovascular Island Flap for Fingertip Amputation

“…Pedicled flaps from the abdomen have several disadvantages, including patient discomfort due to immobilization of the entire hand for 2–3 weeks, the need for flap division, increased hospital stays, a bulky flap, and delayed hand therapy leading to stiffness [ 22 ]. Soft tissue coverage can also be achieved with an abdominal flap, although a shortening of the injured digital length is inevitable.…”

A technical tip in the use of abdominal pedicled flaps in hand reconstruction: A case repot

“…One of the major disadvantages of pedicled abdominal flap reconstruction is postoperative finger stiffness. Al-Qattan et al [4] described technical tips in flap in- setting and hand positioning on the abdomen to allow physiotherapy of the attached hand (before flap division).…”

“…Many tricks and surgical tips have been described while using groin/abdominal pedicled flaps and these have been recently reviewed [4] . In this communication the author presents a case report demonstrating a new technical tip which was utilized in a young child.…”