Use of twin dorsal middle phalangeal finger flaps for thumb or index finger reconstruction

2012 ◽  
Vol 38 (4) ◽  
pp. 387-393 ◽  
Author(s):  
W. Qi ◽  
K. J. Chen
Keyword(s):  
Soft Tissue ◽  
Index Finger ◽  
Middle Finger ◽  
Digital Artery ◽  
Soft Tissue Defects ◽  
The Mean ◽  
Degloving Injuries ◽  
Finger Reconstruction ◽  
Tissue Defects

Amputation or degloving injuries of the thumb or index finger are highly disabling. We describe the use of twin dorsal middle finger flaps harvested from the dorsal aspects of the middle and ring fingers, and based on one palmar proper digital artery, its venae comitantes, and the dorsal branches of the palmar digital nerves of the middle and ring fingers, respectively. These flaps offer advantages when large soft tissue defects of the thumb or index finger are present. In this study, twin dorsal middle finger flaps were used in nine patients (six thumbs, three index fingers). All flaps completely survived. At the mean follow-up of 20 months, the appearance of the reconstructed thumbs or index fingers was acceptable, the length was maintained, and the mean static 2-point discrimination values were 10 mm in the palmar flap and 13 mm in the dorsal flap of the reconstructed digit. All patients were satisfied with the appearance and mobility of the donor fingers. All but one donor finger showed normal finger pulp sensibility, with a static 2-point discrimination between 3 and 6 mm.

Reconstruction of extensive pulp defects of the thumb with a radial-based pedicled flap from the index finger

2018 ◽  
Vol 43 (10) ◽  
pp. 1036-1043 ◽  
Author(s):  
Tulgar Toros ◽  
Yusuf Gurbuz ◽  
Beray Kelesoglu ◽  
Kemal Ozaksar ◽  
Tahir Sadık Sugun
Keyword(s):  
Soft Tissue ◽  
Index Finger ◽  
Pedicled Flap ◽  
Digital Artery ◽  
Soft Tissue Defects ◽  
Digital Nerve ◽  
Donor Side ◽  
Level Of Evidence ◽  
The Mean ◽  
Tissue Defects

This article defines a sensate, pedicled heterodigital flap from the proximal radial side of the index finger for reconstructing large soft tissue defects of the thumb. The pedicle consists of the radial digital artery of the index finger. Dorsal sensory branch of proper digital nerve and one of the terminal sensory branches of radial nerve are included in the flap for sensation. The results of 17 consecutive patients at 24 months revealed mean static two-point discrimination of 7 mm at the reconstruction site and 10 patients were able to feel 4 mm at the reconstructed thumb. The mean range of motion of metacarpophalangeal and interphalangeal joints of operated thumbs reached 94% and 66%, the mean grip span reached 96% compared with the uninjured side. The presented flap provided a simple yet favourable alternative for reconstruction of the thumb tip, with thick and durable tissue requiring minimum dissection and donor side morbidity. Level of evidence: IV

scholarly journals Flow-through arterialized venous free thenar flaps for palmar soft tissue defects in fingers

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052199103
Author(s):  
Song Gu ◽  
Huichao Fu ◽  
Yinjun Huang ◽  
Renguo Xie
Keyword(s):  
Soft Tissue ◽  
Skin Necrosis ◽  
Active Movement ◽  
Soft Tissue Defects ◽  
Injured Side ◽  
Flow Through ◽  
The Mean ◽  
Tissue Defects ◽  
The Average Range

Objective To evaluate the efficacy of venous free thenar flaps for reconstructing palmar soft tissue defects in fingers. Methods From December 2018 to October 2019, 11 patients with palmar soft tissue defects in fingers were treated using venous free thenar flaps. At the final follow-up, the range of thumb radial and palmar abduction on the injured side and opposite side was calculated. The total active movement (TAM) of the injured and opposite fingers and flap sensibility recovery were also recorded. Results The mean follow-up time was 13.4 months, all flaps survived, and all wounds at the donor sites healed with no skin necrosis. At the last follow-up, the average range of thumb radial abduction and thumb palmar abduction on the injured side was 96.6% and 95.9% of the value on the opposite side, respectively. The average TAM of the injured fingers was 98.2% of the value of the opposite fingers. Sensation in the flaps was restored to grade S2 to S3. Conclusion Venous free thenar flaps can be alternatives for reconstructing palmar soft tissue defects in fingers.

scholarly journals Reconstruction of Plantar Forefoot in Diabetic Foot Ulcers: A Comparative Study of Perforator Flaps and Random Flaps

2021 ◽  
Vol 17 (1) ◽  
pp. 19-23
Author(s):  
Yun-Seob Kim ◽  
Si-Gyun Roh ◽  
Jong-Lim Kim ◽  
Nae-Ho Lee ◽  
Jin Yong Shin
Keyword(s):  
Soft Tissue ◽  
Free Flaps ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Soft Tissue Defects ◽  
Perforator Flaps ◽  
The Mean ◽  
Tissue Defects

Background: Plastic and reconstructive surgeons consider a variety of options to salvage limbs of patients when operating on soft tissue defects of the plantar forefoot in diabetic foot ulcers. This study focuses on the efficacy and durability of perforator flaps compared to that of random flaps, when covering the plantar forefoot area in diabetic patients.<br/>Methods: From January 2011 to August 2020, we performed 49 plantar forefoot reconstructions to cover soft tissue defects in diabetes patients using local random flaps, regional perforator-based flaps, or free flaps. The patients’ clinical characteristics, size of defects, surgical outcomes and complications were reviewed retrospectively.<br/>Results: Forty-nine patients underwent plantar forefoot reconstruction over the period reviewed. Eleven patients were female and the others were male. The mean age of the patients was 54.2 years (range, 32–73 years). Median follow-up was 5.2 months. The mean size of the defect was 7.2×4.5 cm. During follow-up periods, partial or complete loss of flaps was closely observed. We identified wound complications in 67% of local random flaps compared to 11% and 21% in regional and free flaps, respectively.<br/>Conclusion: Soft tissue defects in the distal third of the foot can severely worsen diabetic patients’ quality of life. Perforator-based flaps, providing better vascularized tissue than random flaps, can be used to attain acceptable functional and aesthetic results for plantar forefoot reconstruction in diabetes patients.

scholarly journals The Free Flap Based on a Single Proximal Perforator of Radial Artery: the Ultrasonography Study and Clinical Applications in Reconstruction of Digital Defect

2020 ◽  
Author(s):  
Guangzhi Wu ◽  
Zhan Zhang ◽  
Fan Zhang ◽  
Yiqun Zhang ◽  
Wei Yu
Keyword(s):  
Soft Tissue ◽  
Radial Artery ◽  
Soft Tissue Defects ◽  
Proximal Half ◽  
Pedicle Length ◽  
Cosmetic Outcomes ◽  
The Mean ◽  
Artery Perforator ◽  
Tissue Defects

Abstract Objectives: To locate the anastomosable constant perforator of radial artery on the proximal forarm using ultrasonography, and describe the application of free radial artery flap based on a single proximal perforator in the reconstruction of digital soft tissue defects.Methods: In 20 forarms (10 right and 10 left) from 10 volunteers, the perforators in the proximal half of forarm from radial artery were visualized by ultrasonography. Then the free radial artery perforator flaps based on the single perforator were used for reconstruction of small digital soft tissue defects in 4 cases between October 2017 and May 2018.Results: Of the 20 forarms, anastomosable perforator was constantly detected from the radial artery in the proximal half of forarm. The diameter of the perforator was 0.7±0.1 mm, the pedicle length is 12±3 mm by ultrasonography. Ther location of the perforator is far from elbow crease 8.8±1.4 cm, and the relative distance of the perforator location from elbow crease to wrist crease is 37.2% ± 4.8%. In clinical cases, all the flaps were complete survival. Flap size ranged from 3.5 to 6.5 cm in length and 2.3 to 3.0 cm in width. Donor sites of forearm were closed primarily in all cases. During a mean period of 12 months (8-14 months) follow-up, the mean Brief Michigan Hand Questionnaire (BMHQ) score was 72.9 (60.4-85.4) in the affected hand.Conclusions: There is an anastomosable perforator consistent located on the radial artery in the proximal half of forarm. The free radial artery small flap based on this single perforator provides acceptable functional and cosmetic outcomes for the reconsturction of digital soft tissue defects . With the preservation of the main vessel (radial artery) of forearm, this flap provides another reliable option for handsurgery surgeon to reconstruct small digital defects.

scholarly journals Skin stretch suturing with Nice knots in the treatment of small- or medium-sized wounds

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jianmin Xu ◽  
Rui Chang ◽  
Wei Zhang ◽  
Chengcheng Zhang ◽  
Dezhi Zhu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hair Growth ◽  
Wound Closure ◽  
Skin Wound ◽  
Soft Tissue Defects ◽  
Cutaneous Sensation ◽  
The Mean ◽  
Skin Stretch ◽  
Mean Time ◽  
Tissue Defects

Abstract Background To investigate the clinical efficacy and outcomes of skin stretch suturing with self-locking sliding Nice knots in the treatment of small- or medium-sized wounds. Methods From June 2015 to May 2018, 26 patients with small- or medium-sized wounds were included in the present study. Skin stretch suturing with self-locking slide Nice knots was performed to gradually close the soft-tissue defects in these patients. The time of wound closure and healing was recorded. The color and blood supply of the skin, cutaneous sensation, the stretch of skin, and the hair growth situation of the skin wound were observed and recorded. Results There were 17 males and 9 females with an average age of 30.65 years (range, 15–48 years). The areas of the soft-tissue defects were between 3.2 × 7.1 cm and 8.0 × 15.2 cm. All patients underwent stretch suturing with self-locking slide Nice knots to close the soft-tissue defects. All wounds were successfully closed and healed. The mean time of wound closure was 10.69 days (range, 5–20 days), and the mean time of wound healing was 16.85 days (range, 10–24 days). The cutaneous sensation of skin wound recovered normally, and the color of the skin wounds was the same as that of normal skin at the last follow-up. The hair growth situation of the skin wounds also returned to normal. Conclusions This study revealed that Nice knots yielded an accepted clinical result as a new method to close small- or medium-sized wounds that was simple and less minimally invasive, resulted in progressive tension, did not return to previous results, and partially replace flaps or free skin grafts.

scholarly journals Soft tissue reconstruction of low voltage electric burn injuries of the thumb and first web space by the first dorsal metacarpal artery island flap: a three-year study from Eastern India

2020 ◽  
Vol 7 (4) ◽  
pp. 1082
Author(s):  
Madhumita Gupta ◽  
Prabir Kumar Jash
Keyword(s):  
Soft Tissue ◽  
Low Voltage ◽  
Burn Injuries ◽  
Soft Tissue Defects ◽  
Dorsal Metacarpal Artery ◽  
Web Space ◽  
Electric Burns ◽  
Tissue Defects ◽  
First Dorsal Metacarpal Artery

Background: Complex soft tissue defects of thumb and first web space are a reconstructive challenge. Low voltage electric burns of the hand commonly result in localised and deep soft tissue destruction. The first dorsal metacarpal artery flap (FDMA) is an attractive local flap option to reconstruct these. This study illustrates our experience with the same.Methods: Between March 2014 and February 2017, 16 patients with complex soft tissue defects of thumb and first web space resulting from low voltage electric burns underwent reconstruction with the FDMA flap and subsequent structured hand therapy. In the follow up visits objective assessment of hand function included tests of mobility using Kapandji Score, sensory evaluation with static 2 point discrimination and cortical reorientation. The Subjective Satisfaction Score was used to ascertain the patient’s overall perception of aesthetic and functional outcome.Results: Majority (43.75%) of the patients had defects involving the thumb IP joint. No case of complete flap failure was noted. In a mean follow-up of 11.5 months the reconstructed thumb showed return of good protective sensation as well as mobility. Though cortical reorientation was complete in only 18.75 %, it did not substantially impede hand functioning. All patients were satisfied with the functional and aesthetic result.Conclusions: In cases of low voltage electric burn injuries the FDMA flap is a reliable reconstructive option for small to moderate sized complex defects of thumb and first web space. It has minimal donor site morbidity and can be accomplished in a relatively simple single stage procedure.

scholarly journals Ad hoc posterior tibial vessels perforator propeller flaps for the reconstruction of lower third leg soft- tissue defects

2017 ◽  
Vol 50 (03) ◽  
pp. 281-287
Author(s):  
Thalaivirithan Margabandu Balakrishnan ◽  
Jayagosh Ramkumar ◽  
Janardhanan Jaganmohan
Keyword(s):  
Retrospective Study ◽  
Soft Tissue ◽  
Ad Hoc ◽  
Soft Tissue Defects ◽  
Secondary Procedure ◽  
Posterior Tibial ◽  
Minimal Scarring ◽  
Tissue Defects

ABSTRACT Introduction: Lower third leg soft tissue defects with anatomical and pathological constraints are posing formidable challenges to reconstructive surgeon. Aim: This retrospective study was conducted to assess the effectiveness of ad hoc posterior tibial vessels perforator-propeller flaps for the reconstruction of small and medium sized soft tissue defects in the lower third leg. Patients and Methods: 22 patients (16 were males and 6 were females) were involved in this study between period of January 2012 and December 2016. We followed the protocol of initial non delineating exploratory incision made to find out single best perforator in all patients. All the defects in leg reconstructed with adhoc posterior tibial vessel propeller flaps. Results: All 22 flaps survived well. All in an average of 13 months follow up period, had pain free walking, with minimal scarring and acceptable aesthesis at the reconstruction sites with no need for any secondary procedure. Conclusion: With inability of preoperatively dopplering the perforators in the lower third leg region, the exploratory posterior nondelineating incision was used in all cases to secure the single best perforator for the propeller flaps. Thus adhoc posterior tibial vessel propeller flaps are dependable, easily adoptable for the reconstruction of soft tissue defects of the lower third leg region.

scholarly journals Adipofascial perforator flaps: Its role in reconstruction of soft-tissue defects of lower leg and ankle

2018 ◽  
Vol 51 (02) ◽  
pp. 216-221 ◽  
Author(s):  
Deepak Nanda ◽  
Shamendra Anand Sahu ◽  
Durga Karki ◽  
Sanjay Kumar ◽  
Amrita Mandal
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Donor Site ◽  
Soft Tissue Defect ◽  
Soft Tissue Defects ◽  
Adipofascial Flap ◽  
Tibial Artery ◽  
Split Skin ◽  
Tissue Defects

ABSTRACT Background: Despite advances in surgical skills, adipofascial flaps are still less preferred option for coverage of leg defect. We evaluate the use of perforator-based adipofascial flap in small-to-medium-sized soft-tissue defects in the lower limb. Patients and Methods: After localisation of perforators along the major axial vessels in the lower limb using handheld Doppler, adipofascial flap based on the nearest best perforator of anterior tibial artery, posterior tibial artery and peroneal artery was raised to cover soft-tissue defect in 21 patients. The flap was transposed over the defect and covered by split-skin graft. Donor site was primarily closed. Flap complications, functional and aesthetic outcomes are noted in follow-up. Results: There was partial loss of flap in five patients. After debridement and dressings, split-skin grafting was done for four patients and one patient was managed with local flap. Scar over the flap was stable with no reports of recurrent ulceration or breakdown of wound in 6-month follow-up. Four of five patients reported adequate healing of the fractured bone. Average visual analogue score was 8.24/10 for appearance of donor site as evaluated by the patient. Conclusions: Perforator-based adipofascial flap is a good alternative for coverage of small-to-medium-sized soft-tissue defect of the leg, particularly over the malleolus and lower part of the leg. Use of adipofascial tissue and primary closure of the donor site causes minimal donor-site morbidity. Adipofascial perforator flap provides aesthetically superior recipient-site scar with satisfactory functional outcome.

scholarly journals Bone Transport for Treatment of Traumatic Composite Tibial Bone and Soft Tissue Defects: Any Specific Needs besides the Ilizarov Technique?

2020 ◽  
Vol 2020 ◽  
pp. 1-13 ◽  
Author(s):  
Runguang Li ◽  
Guozheng Zhu ◽  
Chaojie Chen ◽  
Yirong Chen ◽  
Gaohong Ren
Keyword(s):  
Soft Tissue ◽  
Deep Infection ◽  
Bone Transport ◽  
Fixation Time ◽  
Ilizarov Technique ◽  
Soft Tissue Defects ◽  
Flap Surgery ◽  
Tibial Bone ◽  
Tissue Defects

Objective. To evaluate the surgical efficacy of bone transport (Ilizarov technique) plus “shortening-lengthening,” “flap surgery,” and “open bone transport” as individualized treatments for traumatic composite tibial bone and soft tissue defects. Methods. We retrospectively analyzed sixty-eight cases (mean age: 35.69 years, (range, 16–65)) treated from July 2014 to June 2017, including 29 middle, 18 distal, and 21 proximal tibial bone defects (4–18 cm, mean: 7.97 cm) with soft tissue defects (2.5 cm × 4.0 cm to 30.0 cm × 35.0 cm after debridement). We adopted the bone transport external fixator to fix the fracture after debriding the defect parts. In the meantime, we adopted the “shortening-lengthening technique,” “flap surgery,” and “open bone transport” as individualized treatment based on the location, range, and severity of the composite tibial bone and soft tissue defects. Postoperative follow-up was carried out. Surgical efficacy was assessed based on (1) wound healing; (2) bone defect healing rate; (3) external fixation time and index; (4) incidence/recurrence of deep infection; (5) postoperative complications; and (6) Association for the Study and Application of the Methods of Ilizarov (ASAMI) score. Results. The mean duration from injury to reconstruction was 22 days (4–80 d), and the mean postoperative follow-up period was 30.8 months (18–54 m). After the repair and reconstruction, 2 open bone transport patients required infected bone removal first before continuing the bone transport treatment. No deep infection (osteomyelitis) occurred or recurred in the remaining patients, and no secondary debridement was required. Some patients had complications after surgery. All the postoperative complications, including flap venous crisis, nail channel reaction, bone nonunion, mechanical axis deviation, and refracture, were improved or alleviated. External fixation time was 12.5 ± 3.41 months, and the index was 1.63 ± 0.44. According to the ASAMI score, 76.47% of the outcomes were good/excellent. Conclusion. The Ilizarov technique yields satisfactory efficacy for composite tibial bone and soft tissue defects when combined with “shortening-lengthening technique,” “flap surgery,” and “open bone transport” with appropriate individualized treatment strategies.

Effectiveness of Calcium Hydroxylapatite Paste in Vocal Rehabilitation

2009 ◽  
Vol 118 (8) ◽  
pp. 546-551 ◽  
Author(s):  
M. Boyd Gillespie ◽  
Thomas S. Dozier ◽  
Terry A. Day ◽  
Bonnie Martin-Harris ◽  
Shaun A. Nguyen
Keyword(s):  
Soft Tissue ◽  
Vocal Fold ◽  
Case Series ◽  
Soft Tissue Defects ◽  
Retrospective Case ◽  
Vocal Rehabilitation ◽  
Calcium Hydroxylapatite ◽  
The Voice ◽  
Tissue Defects

Objectives We determined the effectiveness of calcium hydroxylapatite (CaHA) paste in vocal rehabilitation. Methods We examined a retrospective case series of 39 adult patients who underwent CaHA paste injection for vocal fold rehabilitation over a 5-year period. The outcomes included the change in the Voice Handicap Index (VHI) score; procedure-related complications; and the need for follow-up voice procedures. Results The VHI scores demonstrated overall improvement, with a decrease from the preoperative mean of 61.2 ± 24.0 to a postoperative mean of 35.9 ± 26.3 (p = 0.0001) after a mean follow-up time of 17.8 ± 13.6 months. The procedure was more likely to succeed in patients with paralysis and/or paresis than in patients with glottic soft tissue defects. After injection, the VHI scores worsened in 3 of 7 patients (43%) in the soft tissue defect group, compared to only 2 of 28 (7%) in the paralysis and/or paresis group (p = 0.04). Four of 7 patients with soft tissue defects (57%) required secondary vocal procedures to improve the voice, compared to only 2 of 32 (6%) in the paralysis and/or paresis group (p = 0.006). Conclusions Injection of CaHA paste results in significantly improved vocal scores in the majority of patients. Use of the paste was less satisfactory in patients with soft tissue defects because of poor retention of the paste in the scarred vocal fold remnant.

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