Refining Outcomes in Dorsal Hand Coverage: Consideration of Aesthetics and Donor-Site Morbidity

Parrett, Brian M.; Bou-Merhi, J.; Buntic, Rudolf F.; Safa, Bauback; Buncke, Gregory M.; Brooks, Darrell

doi:10.1097/prs.0b013e3181ef8ea3

Cited by 63 publications

(49 citation statements)

References 21 publications

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“…that were used to cover dorsal hand defects (Level of Evidence: Therapeutic, III) . 63 Evaluated measures included; flap survival, donor-site morbidity and the need for debulking procedures. In addition, a panel of plastic surgeons and non-physician aestheticians subjectively analyzed the final appearance of the flaps.…”

Section: Dorsum Of the Handmentioning

confidence: 99%

Enhancing Aesthetic Outcomes of Soft-Tissue Coverage of the Hand

Rehim

Kowalski

Chung

2015

Plastic and Reconstructive Surgery

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Hand aesthetics in general and aesthetic refinements of soft-tissue coverage of the hand in particular have been increasingly considered over the past few years. Advancements of microsurgery together with the traditional methods of tissue transfer have expanded the armamentarium of the reconstructive surgeon, thus shifting the reconstructive paradigm from simply ‘filling the defect’ to reconstructive refinement to provide the best functional and aesthetic results. However, drawing the boundary between what does and what does not constitute ‘aesthetic’ reconstruction of the hand is not straightforward. The selection amongst the vast amount of currently available reconstructive methods and the difficulties in objectively measuring or quantifying aesthetics has made this task complex and rather arbitrary. In this article we divide the hand into several units and subunits to simplify our understanding of the basic functional and aesthetic requirements of these regions that may ultimately bring order to complexity.

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Section: Dorsum Of the Handmentioning

confidence: 99%

Enhancing Aesthetic Outcomes of Soft-Tissue Coverage of the Hand

Rehim

Kowalski

Chung

2015

Plastic and Reconstructive Surgery

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“…Even radial forearm flaps, which have characteristically less bulk, underwent debulking in 62% of cases. 33 …”

Section: Discussionmentioning

confidence: 97%

“…With current high rates of obesity, large body habitus results in thick fasciocutaneous flaps, which may necessitate considerable debulking. A recent study by Parrett et al 33 found that 88% of ALT flaps utilized required an average of 2 debulking procedures per flap. Even radial forearm flaps, which have characteristically less bulk, underwent debulking in 62% of cases.…”

Section: Discussionmentioning

confidence: 98%

Management of Soft Tissue Defects of the Hand

Yannascoli

Thibaudeau

Levin

2015

The Journal of Hand Surgery

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“…Moreover, flap survival should no longer be the only goalVbulky flaps are not only unsightly but can also limit function if not serially debulked. 4 Because the dorsal finger is cosmetically more unique and important than the dorsal hand, flap choice and outcomes should take into account the final aesthetics of the reconstruction and its match to normal dorsal finger skin; this has not been studied in a large comparative series of flaps. Similarly, outcome should also focus on the secondary interventions needed to achieve the final result such as DB and/or flap separation procedure in multiple dorsal finger defects and the resulting donor-site morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…Conventionally, these injuries are managed with primary soft tissue coverage followed by a later secondary tendon reconstruction. 3 In literature, local or regional flaps are often the preferred choice for soft tissue reconstruction of hand and digits 4 ; however, when facing larger dorsal defects, extensive and multiple digits injuries, these flaps are sometimes precluded and free flaps are frequently considered as the optimal options. 5 Free arterialized venous flaps (AVFs) with the advantages of thin, pliable, easy to elevate, and minimal donor-site morbidity have gained special popularity in the reconstruction of the dorsal finger defects despite of the concerns of inconsistent survival status.…”

mentioning

confidence: 99%

Reconstruction of Large Dorsal Digital Defects With Arterialized Venous Flaps

Yan¹,

Fan²,

Zhang³

et al. 2013

Annals of Plastic Surgery

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Coverage of the dorsal aspect of the fingers is difficult, especially when the defect is large and multiple digits are involved with composite tissue loss and very few conventional flaps are suitable in dealing with such situation. The purpose of this study was to present our experience of reconstruction of the large dorsal digital defects with the arterialized venous flap (AVF) and evaluate its merits and demerits in this clinical setting with a comprehensive review of literature. From August 2008 to December 2010, 7 composite palmaris longus venous flaps and 5 AVFs were used in the reconstruction of extensive dorsal digital injuries in 8 patients, and a comprehensive review of literature regarding the reconstruction of dorsal digital defects with AVFs was carried out. All the flaps survived completely. The outcomes were very satisfactory for functional recovery, aesthetic appearance, and sensation restoration at an average follow-up of 11.8 months; the literature review also revealed the similar results. On the basis of our experience and literature review, AVFs are reliable and good candidates for resurfacing large dorsal digital defects when local flaps are not available or insufficient for coverage. Composite AVF with palmaris longus tendon is an optimal choice for 1-stage reconstruction of dorsal composite finger injuries.

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Refining Outcomes in Dorsal Hand Coverage: Consideration of Aesthetics and Donor-Site Morbidity

Abstract: The aesthetic outcome of dorsal hand reconstruction is dependent on flap choice, with statistically significant differences in revision surgeries and aesthetics among flap types.

Cited by 63 publications

References 21 publications

Enhancing Aesthetic Outcomes of Soft-Tissue Coverage of the Hand

Enhancing Aesthetic Outcomes of Soft-Tissue Coverage of the Hand

Management of Soft Tissue Defects of the Hand

Reconstruction of Large Dorsal Digital Defects With Arterialized Venous Flaps

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