Temporoparietal fascial free flap for correction of first web space atrophy

Fourteen temporoparietal fascial free flaps were used for correction of first web space atrophy from ulnar nerve palsy in 13 patients. Ten sustained ulnar nerve injuries and three suffered from leprosy. The procedures were performed under general anesthesia except one leprosy patient with bilateral ulnar nerve palsy in which local anesthesia and brachial block were employed to harvest bilateral free flaps and recipient site preparations, respectively. The follow‐up time varied from 4 to 64 months. The postoperative results were satisfactory and there was no resorption of the free flaps. The consistency of the augmented first web space was soft and compressible like natural feel. The size of the flap was more than enough for augmentation of first web space and donor site morbidity was minimal and accepted by all patients. We conclude that temporoparietal fascial free flap is an ideal autogenous tissue for correction of first web space atrophy. © 2009 Wiley‐Liss, Inc. Microsurgery 2010.     

Use of the free prefabricated temporoparietal fascia-chondro-cutaneous flap nourished by only arterial inflow: an arterial flap

Summary Pedicled temporoparietal fascial flaps have been used extensively in head and neck reconstruction for many years. Also, the fascia has been grafted, and the skin graft transformed into a vascularized pedicled flap (prefabricated temporoparietal fasciocutaneous flap). On the other hand, some authors have used free temporoparietal fascial flaps for defects that require to be filled in lower and upper extremity wounds. In this case, a free prefabricated temporoparietal fascio-chondro-cutaneous flap having only an arterial inflow was used in eyelid reconstruction.Presented at the 14th Congress of Turkish Plastic and Reconstructive Surgery, Ankara, Turkey, October 1992     

Clinical application of a free scapular fascial flap

The free scapular fascial flap based on the circumflex scapular vessels with skin graft on top has been used to cover the soft-tissue defects in 6 cases--5 hands and 1 foot, over the past one year. The size of the fascial flap ranged from 10 x 6 to 13 x 7 cm. Five flaps were survival completely and one with loss of a small portion due to infection. Compared with the cutaneous flap, myocutaneous flap or muscular flap, the fascial flap is thinner, showing no bulkiness on the recipient site, and also no impairment was noted in the donor site. The shortcoming is darker colour of the skin graft overlying it. The authors consider that the free fascial flap is mainly indicated for the soft-tissue defects of the extremities and those sites where no augmentation is required.     

Free temporoparietal fascial flaps and full-thickness skin grafts in aesthetic restoration of the nose

Free tissue transfers have been rapidly replacing distant flaps for use in nasal reconstruction. The temporoparietal fascial flap is a thin, broad, pliable, and well-vascularized flap. It can be used to drape over the cartilaginous and bony framework of the nasal skeleton and nourish the underlying primary cartilage grafts as well as the overlying full-thickness skin graft. The thin contour of the flap is aesthetically superior to thicker skin flaps and eliminates the need for secondary defatting or touch-up procedures. A large, single sheet of full-thickness skin graft, harvested from the supraclavicular region, can be applied over the fascial flap in the same session and provide a quite acceptable color match. The authors present a case whose alar margins and atrophic nasal skin were restored in one session by primary conchal cartilage grafts, a free temporoparietal fascial flap, and a full-thickness supraclavicular skin graft.     

复杂指蹼挛缩和皮肤缺损的显微外科重建

目的：研究复杂指蹼挛缩和缺损的显微外科重建技术。方法：应用７种岛状皮瓣和１０种游离皮瓣重建指蹼４４例，其中应用联合移植方法同时重建虎口和拇指８例。结果：皮瓣全部成活，平均经１５个月随访，疗效优２５例，良１７例，可２例。结论：指背和手背岛状皮瓣适合修复小面积指蹼缺损，骨间背侧动脉皮瓣是修复中等指蹼创面的较佳选择，脐旁皮瓣和股前外侧皮瓣能重建大面积和不规则指蹼缺损。本组经验显示，缝合皮神经的皮瓣疗效稍优，趾蹼皮瓣重建的指蹼综合效果最佳，联合移植能有效地一期再造拇指和指蹼。     

Endoscopic harvest of temporoparietal fascial free flaps for coverage of hand wounds

The temporoparietal fascial (TPF) flap is a thin, pliable, and well-vascularized flap that is ideal for reconstructing hand defects. Conventionally harvested flaps, however, result in a large scar over the temporal fossa, which may be problematic in patients with male-pattern baldness. We describe an endoscopic technique for harvesting the TPF flap through a 4-cm preauricular incision to reduce donor site morbidity. Five TPF flaps were used to cover hand wounds. Three of the flaps were successful and there were no injuries to the frontal branch of the facial nerve in this series. Endoscopic harvest of the TPF flap is an ideal solution for covering medium-sized hand defects without potentially prominent scars in the temporal area.     

Application of different types of free foot flaps in hand surgery

From 1987, nine types of free vascularized flaps or combined flaps from the foot were used to treat 26 cases of hand injury with tissue loss. They were: (1) combined flap of 4 toe dorsums, big toe pulp, first toe web, and dorsalis pedis flap with long extensor tendons of the toes, (2) composite skin flap with the second metatarsophalangeal joint, (3) wrap-around flap from the great toe, (4) first toe web flap, (5) toe pulp flap with only an artery and a nerve, (6) wrap-around flap of the great toe with a dorsalis pedis flap, (7) second toe with dorsalis pedis flap, (8) dorsalis pedis flap, and (9) first toe web flap with second metatarsal bone. All flaps survived. All the patients have used their reconstructed hand. Of the final motor functions of the reconstructed hands, 68.8% are excellent, 27.3% are good, 3.9% are fair. Of the final cosmetic results of the reconstructed hands, 76.9% are excellent, 15.3% are good, 7.8% are acceptable. Of the patients, 64.9% are satisfied with the final results of the donor sites, 31.2% feel it is acceptable, and 3.9% feel it is unsatisfactory. The selection, indication, merits and demerits of vascularized foot flaps and attentive points in the operations are discussed in this paper. © 1995 Wiley-Liss, Inc.     

Use of free dorsoulnar perforator flap in the treatment of postburn contractures of the fingers

BACKGROUND: Burns of the hand cause not only the impairment of hand function but also cosmetic deformity. Cases with dysfunctional hands with severe contractures increase if rehabilitation of the acutely burned hand is not done properly. PURPOSE: We present the use of free dorsoulnar perforator flap in the treatment of postburn contractures as an alternative when local flaps cannot be used. METHODS: Free dorsoulnar perforator flap was used in the treatment of seven hands with postburn contracture. Five of them had multiple digital postburn flexion contractures. Combined use of cross-finger and side finger transposition flaps was preferred when the adjacent finger was suitable for being cross-finger flap donor. When the adjacent finger was not suitable for being cross-finger flap donor, the free dorsoulnar perforator flap was preferred. Two of the patients had postburn web contractures. Free dorsoulnar perforator flap was used to release the web and to form a new web commissure. CONCLUSION: The free dorsoulnar perforator flap could be a good alternative to cover the defects created with the hand contracture release.     

游离腓动脉穿支筋膜瓣修复手部皮肤缺损

目的 探讨应用游离腓动脉穿支筋膜瓣修复手部软组织缺损,减少供区损伤的方法和临床效果.方法 2007年12月至2009年10月,对6例手部皮肤缺损患者,应用游离腓动脉肌皮穿支筋膜瓣进行修复,切取面积为5.0 cm×4.5 cm～10.0 cm×7.0 cm,以肌皮穿支为蒂.动脉血管蒂与受区血管采用端侧吻合,受区筋膜瓣行断层植皮覆盖.供区创面直接缝合.结果 术后6例筋膜瓣全部存活;术后7 d,筋膜表面植皮成活大于90%4例,80%2例.随访时间为3～12个月,1例皮瓣臃肿,术后3个月行皮瓣修整术;5例皮瓣略臃肿,外观满意.小腿供区仅留线条瘢痕.结论 腓动脉穿支筋膜瓣是在腓动脉穿支皮瓣基础上的改良,目的 是减少供区创伤,改善小腿外观.筋膜瓣本身可以填充组织缺损,为功能重建提供条件.     

Fascial flaps based on perforators for reconstruction of defects in the distal forearm.

Twenty fascial flaps were used in the reconstruction of defects in the distal forearm, wrist and hand in 18 patients over a 2-year period. In 16 patients the fascial flaps were based on a single fascial feeding vessel or 'perforator' arising from the anterior interosseous artery and/or ulnar artery when the radial artery had been used as the donor vessel in free flap reconstruction elsewhere in the body. There was no loss of any fascial flap in the study. The use of fascial flaps based on fascial feeders of the anterior interosseous and ulnar arteries extends the range of fascial flaps that can be raised in the forearm for reconstruction of defects in the distal forearm, wrist and hand.     

吻合血管股前外侧筋膜瓣的临床应用

目的探讨吻合血管股前外侧筋膜瓣修复前臂及手部创面的临床应用。方法2000年9月-2003年12月收治前臂及手部软组织缺损13例,男8例,女5例;年龄19-43岁。机器碾压伤3例,皮带绞伤4例,重物压伤6例。软组织缺损部位前臂掌侧6例,手背部6例,食指桡、背侧1例。缺损范围17.5cm×7.7cm-4.6cm×3.4cm,其中4例合并前臂、手部骨折,9例合并前臂、手部伸肌腱损伤。患者均急诊行清创、骨折复位内固定,修复损伤的神经、肌腱及血管,术后抗感染治疗3-5d后,采用吻合血管的股前外侧筋膜瓣联合中厚皮片植皮修复软组织缺损。结果术后患者均无血管危象发生。1例第4、5指蹼处约2.0cm×1.0cm植皮坏死,经换药及再次取全厚皮植皮后成活,余患者筋膜瓣及植皮均成活。全部获3-12个月随访,修复后的创面外形均良好,无皮肤挛缩。按中华医学会手外科学会上肢部分功能评定标准优9例,良2例,可1例,差1例,优良率85%。结论吻合血管股前外侧筋膜瓣联合植皮修复前臂及手部创面外形好,不需再次手术整形,远期无皮肤瘢痕挛缩发生,供区处理简单,创伤小。     

Early coverage of deep hand burns with groin flaps

Deep burns of the hands require skin flap coverage in order to protect the exposed vital structures. The groin flap is a safe and effective method of obtaining early closure of these defects. We have used groin flaps to cover deep hand burn defects in nine patients. In each case, groin flaps effectively covered the various defects, such as the volar aspect of the wrist, dorsum of the hand, first web space, thumb, and fingers.     

游离足背皮瓣修复手背皮肤软组织缺损

目的 探讨游离足背皮瓣修复手背皮肤软组织缺损的临床效果.方法 对10例手背软组织缺损的患者,切取带腓浅神经的游离足背皮瓣移植修复,其中1例携带第3、4趾趾长伸肌腱,1例同时切取第二足趾再造中指.皮瓣切取面积为5 cm×4 cm～21 cm x 12 cm.结果 10例皮瓣全部存活,术后1例皮瓣发生血管危象,经手术探查发现静脉血栓形成,重新吻合血管后皮瓣存活.术后随访6～24个月,其中9例皮瓣无臃肿,皮肤质地、色泽接近正常皮肤,痛、温、触觉部分恢复;1例皮瓣肤色较深,质地硬.3例供区植皮坏死、肌腱外露,其中1例经换药后瘢痕愈合,1例行小腿内侧筋膜皮瓣修复,1例行足内侧岛状皮瓣修复.结论 应用足背皮瓣复合组织修复手背皮肤、肌腱和神经的缺损,是一种较理想的方法.     

Versatility of the lateral arm free flap in various anatomic defect reconstructions

The free lateral arm flap may be harvested as a fascial, fasciocutaneous, or osteofasciocutaneous flap. Simultaneous flap elevation with preparation of the recipient site, easy dissection, minimal donor-site morbidity, and a constant vascular anatomy with long pedicle are advantages of the flap. In this study, the authors present 18 patients operated on between January, 2002 and August, 2003 in whom 18 free lateral arm flaps were utilized. There were four women and 14 men, and the mean patient age was 40 years. Thirteen fasciocutaneous, three fascial, and two osteofasciocutaneous flaps were used. Flaps were employed for the reconstruction of the lower extremity in five patients, upper extremity in nine patients, and head and neck in four patients. Thirteen flaps were elevated under axillary block and five flaps under general anesthesia. Aspirin, dipirydamol, dextran, and chlorpromazine were administered postoperatively. Venous insufficiency developed in two lower-extremity reconstructions on postoperative day 1. Venous thromboses were detected, anastomoses were re-done, and flaps healed uneventfully. No other postoperative complication was observed in the other patients. The free lateral arm flap may be used in various anatomic defects with various indications. It may be elevated under axillary block for extremity reconstructions.     

Clinical study of dorsal ulnar artery flap in hand reconstruction

Soft tissue defects of hand with exposed tendons, joints, nerves and bone represent a challenge to plastic surgeons. Such defects necessitate early flap coverage to protect underlying vital structures, preserve hand functions and to allow for early rehabilitation. Becker and Gilbert described flap based on the dorsal branch of the ulnar artery for defects around the wrist. We evaluated the use of a dorsal ulnar artery island flap in patients with soft tissue defects of hand. Twelve patients of soft tissue defects of hand underwent dorsal ulnar artery island flap between August 2006 and May 2008. In 10 male and 2 female patients this flap was used to reconstruct defects of the palm, dorsum of hand and first web space. Ten flaps survived completely. Marginal necrosis occurred in two flaps. In one patient suturing was required after debridement and in other patient wound healed by secondary intention. The final outcome was satisfactory. Donor areas which were skin grafted, healed with acceptable cosmetic results. The dorsal ulnar artery island flap is convenient, reliable, and easy to manage and is a single-stage technique for reconstructing soft tissue defects of the palm, dorsum of hand and first web space. Donor site morbidity is minimal, either closed primarily or covered with split thickness skin graft.     

The scapular/parascapular flap in reconstruction of distal lower extremity soft tissue defects over the Achilles tendon

Combined defects of soft tissue and Achilles tendon are rare and are usually seen following repair of the tendon. Large size defects frequently cannot be reconstructed with local tissue. Various free flaps such as the radial forearm flap and the temporoparietal fascia flap have been described for reconstruction. In selected cases with concomitant Achilles tendon defect or loss of gliding tissue, the fasciocutaneous scapular/parascapular flap with an axial fascial extension offers considerable advantages. Three cases with soft tissue and Achilles tendon defects have been treated with a scapular/parascapular flap during an 18 months period. The defect size ranged from 8×9 or 6×15 cm. All flaps survived, donor site morbidity was not significant and primary donor site closure was possible in all cases. Achilles tendon function was good in two cases and fair in one case. One flap had to be revised to produce better contour, but the other flaps were aesthetically pleasing. The scapular/parascapular flap with fascial extension is a useful addition in reconstruction of combined soft tissue and Achilles tendon defects. The axial fascial part is versatile and can be wrapped around the tendon to provide tendon reinforcement, gliding tissue or both. The thickness of the flap is uniform and a custom tailored flap is possible. Received: 7 July 1997 / Accepted: 25 May 1998     

Injuries of the first web. Surgical indications

Treatment of the first web injuries are based on the concept of one stage repair of the complex injuries of the hand with early motion. Radical debridement is specially important in case of muscular attrition. Fasciotomie of the first web is systematic in case of crush injuries for avoiding compartimental syndrome. For prevention of first web retraction, one or two Kirchner wires are placed in emergency between first and second metacarpal, and later a spilt in maximal anti-position of the first ray. In case of communited fractures, skeletal stabilisation use inlay internal devices, such the blocked intramedullary nail. First web reconstruction must take into consideration the cutaneous functionnal units of the hand, described by Michon. Thin and split-thickness grafts are rarely used for covering skin defects of the first web space, because their ability of retraction. Exposition of bone or tendons leads to the realisation of a flap. Soft tissue coverage must be achieved in emergency or after a second look within the first 48 hours. The kite flap is the most useful local flap for the first web space. The interosseous flap is the best choice among the regional pedicled flap. The use of the Chinese flap must be very careful, because the possibility of contusion of the radial pedicle in these types of injuries. It is only in case of contra-indication of the interosseous flap that free flaps can be realised, as the lateral arm flap or the parascapular flap. The groin flap keeps few indications for aesthetic reasons, or when regional flaps and microsurgery are contra-indicated.     

掌背动脉筋膜瓣修复手指背侧组织缺损

目的 报道应用带掌背动脉的筋膜瓣加游离植皮修复手指背侧组织缺损的临床疗效.方法 2003年12月-2009年12月共治疗手指背侧组织缺损36例,根据手指指背软组织缺损情况,分别采用了顺行带掌背动脉筋膜瓣（10例）、逆行带掌背动脉筋膜瓣（20例）和U-I型掌背动脉筋膜瓣（6例）进行修复.筋膜瓣面积：1.2cm×2.1cm～2.5cm×4.5cm.结果 36例筋膜瓣加植皮区全部成活,术后随访1～12个月,平均6个月,其中31例外形和功能恢复较为满意（86 %）,5例不满意（14%）.结论 选用带掌背动脉筋膜瓣加游离植皮修复手指背侧组织缺损,具有手术操作相对简便,对供区影响小,外形良好,不损伤指固有动脉及神经等优点,可一、二期修复手指背侧不同部位的皮肤缺损.     

Coverage of soft-tissue defects of the hand with free fascial flaps

Coverage of exposed functional structures such as tendons, bones, vessels, or nerves at the dorsal and palmar surface of the hand requires thin, supple tissue to provide adequate range of motion and a satisfying aesthetic result. The purpose of this retrospective study was to evaluate the functional and aesthetic results after coverage of the hand with free fascial flaps. From 1994-2002, 14 patients underwent free fascial flap coverage of the hand with 4 tempo-parietal fascia flaps and 11 serratus fascia flaps. Eight patients could be reexamined and answered a questionnaire about their satisfaction with the functional and aesthetic results. The mean follow-up was 41.7 months. Average active range of motion of the hand, functional improvement, and the aesthetic result were satisfying in all follow-up patients. No secondary debulking or other contouring procedures were required. We recommend the use of free fascial flaps as a valuable alternative to fasciocutaneous or muscle flaps, since the functional results are excellent, no additional procedures were necessary, and the aesthetic results are appealing.     

Reconstruction of iatrogenic dorsal skin defects of hands with reverse forearm flaps

Summary Distally based radial and ulnar forearm flaps were employed to reconstruct iatrogenic dorsal skin defects of hands in young children. The defects resulted from the extravasation of intravenous medication; flaps were required for reconstruction because the extensor tendons were exposed in the base of the ulcer in Case 1 and were involved in dense scar tissue in Case 2. The reverse forearm flap is an easy and reliable technique requiring short operating time, and it allows initiation of early physiotherapy compared with the other techniques, such as free flap or an abdominal flap.