Reversed Island Forearm Fascial Flap in Hand Surgery

Jin, Yi-Tao; Guan, Wenxiang; Shi, Tao-ming; Quian, Yong-liang; Xu, Lili; Tc, Chang

doi:10.1097/00000637-198510000-00011

Cited by 54 publications

(29 citation statements)

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“…All efforts should be made to improve donor site appearance. We therefore prefer to harvest the flap as a fascial flap as described by Jin [15], especially in staged coverage. This variation offers a superior esthetic outcome of the donor site as well as the recipient site [9].…”

Section: Discussionmentioning

confidence: 99%

“…Harvest of the flap as a fascial flap results in a more appealing donor site but makes additional skin grafting necessary in the recipient site [15]. Nevertheless, the appearance of the donor site remains to be a severe clinical drawback of the radial forearm flap.…”

Section: Historical Perspective and Indicationsmentioning

confidence: 99%

“…Latter may not be sufficient in larger free flaps; however, distal venous anastomoses are rarely necessary for pedicled flaps. Multiple anastomoses between the forearm veins permit venous drainage despite intact valves, avoiding the need for valvulotomies [15].…”

Section: Anatomymentioning

confidence: 99%

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The Evolution of the Pedicled Radial Forearm Flap

Megerle

Sauerbier²,

Germann

2009

Hand (New York, N,Y.)

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Because of the thin skin envelope of the hand, especially at the dorsum, flaps are frequently required for defect reconstruction in the hand. The pedicled radial forearm flap is a time proven procedure that offers reliable coverage in this area without the need of advanced microsurgical expertise. Despite several alternatives and an increasing acceptance of free tissue transfers, the pedicled radial forearm flap can still be the procedure of choice under special circumstances. Variations of the original technique address the two main disadvantages, the conspicuous donor site and the sacrifice of the radial artery. Indications, anatomy, surgical technique, and limitations of this classic workhorse flap are presented.

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Section: Discussionmentioning

confidence: 99%

Section: Historical Perspective and Indicationsmentioning

confidence: 99%

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The Evolution of the Pedicled Radial Forearm Flap

Megerle

Sauerbier²,

Germann

2009

Hand (New York, N,Y.)

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“…The reversed radial forearm fascial flap covered with a free skin graft has been used by Jin et al (17) following first web burn scar release in 17 patients, many of whom also had dorsal scars of the wrist as well as MP joint hyperextension, but undamaged volar forearm skin. Cherup et al (18) used this flap lifted from a forearm that had previously had STSG applied to fascia.…”

Section: Discussionmentioning

confidence: 99%

Split-thickness skin graft coverage following release of postburn first web space adduction contracture

Snelling

Eva

1999

CAN J PLAST SURG

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A dduction contraction of the first web space following burn injury can disable the hand by reducing the thumbindex span, limiting the size of objects that can be grasped. Severe proximal palmar scarring can produce transverse cupping, and full flexion of the index and long fingers may be blocked by the thumb if it is permanently pronated across the palm. PAPERS AND ARTICLESThis paper was presented to the Northwest Plastic Surgery Society, January 31, 1996, Whistler, British Columbia and, in part, at Twelve patients from 11 to 57 years of age who underwent surgical release of postburn first web space thumb adduction-pronation contracture had the resulting defect resurfaced successfully with a medium-thickness, unmeshed, split-thickness skin graft (STSG). This procedure provided satisfactory, durable cover and maintained the gain in thumb abduction. All hands had combined dorsal and volar scarring that required incision. If indicated, partial division of the midbelly of the distal border of the adductor and distal midborder of the first dorsal interosseous was performed to increase both radial and palmar thumb abduction. Immediate or delayed skin grafting, the latter with a dynamic grafting splint, was carried out. Fifteen hands (from 12 patients) were assessed one year or more after surgical release. The mean postoperative radial abduction angle measured on photographs between the first metacarpal shaft and index proximal phalanx was 42°±13°, which was greater than the preoperative mean of 23°±12°(P=0.001) but less than the mean of 57°±12°for 20 nonburned control subjects (P=0.002). The mean postoperative palmar abduction angle measured between the first metacarpal and the proximal phalanx of the index finger was 54°±19°, which was greater than the preoperative mean of 18°±21°(P<0.001). An STSG was simple and quick to harvest for the burned hand at or near full growth size, and was successful in maintaining the increased abduction gained in the first web space for most of the patients who were treated. Key Words: Burn hand; Burn scar; First web space contracture; Hand reconstruction; Skin graft; Thumb adduction contractureRevêtement par greffe de peau demi-épaisse après la libération d'une rétraction en adduction de la première commissure du pouce survenue après une brûlure RÉSUMÉ : Douze patients âgés de 11 à 57 ans chez qui on a procédé à une libération chirurgicale d'une rétraction en adduction-pronation de la première commissure du pouce survenue après une brûlure ont, pour cacher les cicatrices résultant de cette intervention, subi avec succès un resurfaçage avec une greffe de peau demi-épaisse, sans filets, d'épaisseur moyenne. Cette intervention a fourni un revêtement durable et satisfaisant et maintenu l'augmentation de l'adduction du pouce. Toutes les mains avaient une combinaison de cicatrices antérieures et dorsales qui ont nécessité une incision. Lorsqu'il y avait indication, une division partielle du corps moyen du bord distal de l'adducteur et du bord moyen distal du premier interosseux dorsal a...

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“…It is divided 2 cm bilaterally. The adipofascial pedicle (3À4 cm wide) is elevated with (9) Scar contracture (5) the skin island flap. There is no need to identify the small perforators around the radial styloid process in order to avoid damage.…”

Section: Operative Techniquementioning

confidence: 99%

Distally based radial forearm flap with preservation of the radial artery: Anatomic, experimental, and clinical studies

et al. 2003

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In this article we report on the anatomical, experimental, and clinical investigations of the distally adipofascial pedicled radial forearm flap based on the small perforators around the radial styloid process. There are about 10 small perforators (0.3-0.5 mm in diameter) from the distal radial artery around the radial styloid process. The longitudinal chain-linked vascular plexuses (suprafascial, paraneural, and perivenous) formed by the forearm ascending and descending branches of septofasciocutaneous perforators meet and cross over with the transverse carpal vascular plexuses around the radial styloid region. Based on these directional-oriented plexuses, distally based adipofascial pedicled radial forearm fasciocutaneous and adipofascial flaps were designed and successfully applied in 34 clinical cases. The pivot point was located at 1-2 cm above the radial styloid. The skin island plus adipofascial pedicle measured between 9-18 cm in length, with the adipofascial pedicle 3-4 cm in width. The length-to-width ratio is 3-5:1. The venous drainage of this distally based flap was investigated anatomically and experimentally. The cephalic vein has no positive role for venous drainage in distally based flaps. The difference between distally based flaps and reverse-flow flaps, clinical selection of fasciocutaneous and adipofascial flaps, advantages and disadvantages, and technical tips for operative success are discussed.

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Reversed Island Forearm Fascial Flap in Hand Surgery

Cited by 54 publications

References 0 publications

The Evolution of the Pedicled Radial Forearm Flap

The Evolution of the Pedicled Radial Forearm Flap

Split-thickness skin graft coverage following release of postburn first web space adduction contracture

Distally based radial forearm flap with preservation of the radial artery: Anatomic, experimental, and clinical studies

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