Use of composite anterolateral thigh flap as double-vascularised layers for reconstruction of complex hand dorsum defect

Yazar, Sevgi Kurt; Gideroğlu, Kaan; Kılıç, Birim Günay; Gökkaya, Ali

doi:10.1016/j.bjps.2008.06.016

Cited by 13 publications

(20 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our work supports the work of others (Adani et al, 2006;Chen et al, 1999;Kimura et al, 2008;Muneuchi et al, 2002;Yazar et al, 2008) regarding the reliability of ALT flaps in hand reconstruction.…”

Section: Discussionsupporting

confidence: 91%

Composite anterolateral thigh perforator flaps in the management of complex hand injuries

Meky

Safoury

2011

J Hand Surg Eur Vol

View full text Add to dashboard Cite

The anterolateral thigh (ALT) fasciocutaneous flap has been well described for hand skin cover, however its use in its composite (multiple tissue) form incorporating bone, muscle and/or fascia has been less well described. We report the usefulness of the composite ALT flap in six complex hand trauma cases, four male and two female (age range 14-46 years). The palm of the hand was affected by injury in three cases, the dorsum in two cases, and the radial side in one case. The first web formed part of the injury in three cases. There was variable involvement of the tendons, nerves and bones. Fascia lata was included in the flap to provide a gliding surface in four cases, part of the vastus lateralis muscle was included to obliterate dead space in two cases and to create a first web in one case, and a bone block from the iliac crest was included to reconstruct the lost metacarpals in one case. All flaps survived with minimal complications. This work shows that the anterolateral thigh composite flap is a reliable option when multiple tissue types are required in hand reconstruction.

show abstract

Section: Discussionsupporting

confidence: 91%

Composite anterolateral thigh perforator flaps in the management of complex hand injuries

Meky

Safoury

2011

J Hand Surg Eur Vol

View full text Add to dashboard Cite

show abstract

“…Free anterolateral thigh (ALT) flap may be a good option for the reconstruction of the large and complex defects of the upper limb. [7,8] Huge skin islands can be elevated from the thigh to close the large defects exposing the tendons, nerves and bones in this region. Free ALT flap is a right versatile flap since it can be harvested with the tendon of tensor fascia lata for a vascularized tendon reconstruction, [9] with the vastus lateralis muscle to fill dead spaces, [10] or with the lateral femoral cutaneous nerve for the neurotization of the transferred skin paddle.…”

Section: Discussionmentioning

confidence: 99%

Versatile Use Of 'The Posterior Interosseous Flap' In The Reconstruction Of Complex Upper Limb Defects

Barin

Çinal

Kara³

et al. 2019

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

BACKGROUND: Reconstruction of the complex upper extremity defects is a challenging procedure for reconstructive surgeons because of the complex anatomical and functional structure of this region. In reconstruction, local and regional flap options involving the composite tissues are restricted. The posterior interosseous flap (PIO) has been presented "in a single study" with a wide variety of uses, and in this study, the versatility of PIO has been tried to be emphasized by its multitude uses as well as its chance at adaptability to each case. Hence, due to this, the objective to highlight the versatile utility of the PIO flap in clinical practice and to present a good option for the reconstruction of complex upper limb defects for various cases have been targeted. METHODS: We used 26 PIO flaps in 25 patients (18 male and seven female patients) with upper limb defects. The main etiological causes were burn contracture, traffic accident, firearm and acute burn injury. Twenty-two flaps were harvested as fasciocutaneous and four flaps as osteo-fasciocutaneous manner, which were applied to the metacarpal defects. In this study, 25 flaps were transferred as pedicled flaps, of which 23 and 2 flaps had reverse and antegrade blood flows, respectively, whereas one flap was used as a free flap. RESULTS: The mean follow-up period was 14 months. All flaps except one, which had partial necrosis and secondary healed, survived completely. All patients were able to gain basic functions for daily routine activities in the late postoperative period. Patients and/ or their parents were satisfied with the postoperative functional and aesthetic improvements. CONCLUSION: Many advantages of the PIO flap make it useful for the reconstruction of upper limb complex defects. It can be versatilely used based on changing its flow direction and enrichment of contents.

show abstract

“…Revascularization of bone autograft graft takes a very long time, and resistance to infection is minimal (Addosooki et al, 2016;Weiland et al, 1984). On the other hand, the use of vascularized composite osteocutaneous flap can treat bone and soft tissue defects simultaneously and provides a vascularized bone graft that is resistant to infection (Datiashvili et al, 1992;Momeni & Stark, 2006;Tropet et al, 1995;Yazar et al, 2008). bone, which is appropriate to bridge wide defects.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment becomes more complicated and challenging when local soft tissue (skin and/or tendons) is involved (Datiashvili, Shibaev, Chichkin, & Oganesian, ). Various combinations of vascularized and nonvascularized grafts are used to treat such complex injuries (Akin, Ozgenel, & Ozcan, ; Momeni & Stark, ; Tropet, Brientini, Garbuio, Ridoux, & Vichard, ; Yazar, Gideroglu, Kilic, & Gokkaya, ). The nonvascularized bone graft is preceded by soft tissue reconstruction using local pedicled or distant flaps.…”

Section: Introductionmentioning

confidence: 99%

“…Various combinations of vascularized and nonvascularized grafts are used to treat such complex injuries (Akin, Ozgenel, & Ozcan, 2002;Momeni & Stark, 2006;Tropet, Brientini, Garbuio, Ridoux, & Vichard, 1995;Yazar, Gideroglu, Kilic, & Gokkaya, 2008). The nonvascularized bone graft is preceded by soft tissue reconstruction using local pedicled or distant flaps.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Reconstruction of complex hand defects using trapezoidal osteocutaneous free fibular flap

et al. 2019

View full text Add to dashboard Cite

Background Traumatic defects of multiple metacarpal bones can be addressed using conventional or vascularized bone grafts. When associated with extensive skin and tendon loss, the treatment becomes more challenging. The aim of the study was to describe the results of using free osteocutaneous fibular flap placed in a new fashion for the reconstruction of complex hand defects. Patients and Methods Six patients with complex hand defects underwent reconstruction using free osteocutaneous fibular flap placed in trapezoidal fashion with two‐stage tendon reconstruction using fascia lata graft. The mean age at the time of injury was 34.7 years (range: 14–54 years). The injury was caused by motor vehicle accident in four patients, machine injury in one patient, and falling from height in one patient. All patients had extensive three or four metacarpal bones defects, segmental loss of tendons, and large skin defect ranging from 6 × 10 cm to 10 × 15 cm. The fibular graft was divided into three segments and positioned in a trapezoidal fashion with the middle bone segment placed transversely to support the bases of the proximal phalanges while the first and third bone segments were placed obliquely along the metacarpal axis converging toward the remaining metacarpal bases and/or carpal bones. At final follow‐up visit, the finger range of motion was assessed using the total active motion (TAM) scoring system. Functional outcome was evaluated by the disabilities of the arm, shoulder and hand (DASH) score. Active range of motion (AROM) of the pseudo‐metacarpophalangeal (MP) joint was measured. The handgrip strength was measured using Jamar hydraulic dynamometer. Results The mean length of the harvested fibular graft was 18 cm (range: 17–19). The mean size of the skin paddle was 7.5 × 13.1 cm (range: 6 × 10 cm to 10 × 15 cm). Fibular flaps survived in all patients. The mean follow‐up period was 30.8 months (range: 24–40 months). The mean time to achieve bone healing was 3.8 months (range: 3–5 months). The mean TAM was 185° (range: 165–204°) and TAM percentage was described as excellent in two patients and good in four patients. The mean AROM at the pseudo‐MP joint was 53.8° (range: 42–70°). The mean injured handgrip strength was 27.3 kg (range: 23–31 kg) and the mean grip strength ratio was 74.8% (range: 69–80%). The mean DASH score was 19.6 (range: 11.67–26.67). Pin tract infection, partial skin paddle necrosis, and wound infection were reported. Conclusion The fibular osteocutaneous flap arranged in trapezoidal fashion is a viable choice for the reconstruction of complex hand defects, particularly when the metacarpophalangeal joints are not preserved.

show abstract

Use of composite anterolateral thigh flap as double-vascularised layers for reconstruction of complex hand dorsum defect

Cited by 13 publications

References 5 publications

Composite anterolateral thigh perforator flaps in the management of complex hand injuries

Composite anterolateral thigh perforator flaps in the management of complex hand injuries

Versatile Use Of 'The Posterior Interosseous Flap' In The Reconstruction Of Complex Upper Limb Defects

Reconstruction of complex hand defects using trapezoidal osteocutaneous free fibular flap

Contact Info

Product

Resources

About