- Email: [email protected]
A-0330 14.4 The digito-metacarpal dorsal flap: a useful dorsal hand flap for covering important long fingers skin defects
ARTICLE IN PRESS FLAPS IN HAND RECONSTRUCTION
reconstruction with a one stage operation, they always need a wide dissection, which may lead to volar scarring. The majority of these problems can be avoided with the use of the dorsal island homodigital flap. After debridement of the recipient area the length and width of the skin defect is measured and a flap is raised by making an incision across the dorsum of the digit 4 to 5 mm proximal to the eponychium between the two midlateral lines. It is based on the side of the proximal edge of the obliquity of the amputation stump and is islanded on a subcutaneous tissue pedicle that includes a dorsal artery and a nerve branch. From October 2005 to October 2006 the dorsal island homodigital flap was used in 12 patients and we are presenting our experience in the use of this flap.
59
a partial suffering of the flap extremity, occurring in smoker patients. The treatment consisted of surgical debridement and secondary healing without alteration of the final outcome. The donor site was either primarily closed with the adding of discharge incisions whenever necessary, or left to secondary healing when the width of the flap exceeded 2.5 cm. We never used skin graft. 10.1016/j.jhse.2007.02.160
A-0313 14.5 GRACILIS FREE MUSCLE FLAP FOR COVERAGE OF PALMAR DEFECTS
10.1016/j.jhse.2007.02.159
N. Chahidi, P. Lorea, A. Le Jeune and K. Drossos Clinique du Parc Le´opold Bruxelles, Belgium A-0330 14.4 THE DIGITO-METACARPAL DORSAL FLAP: A USEFUL DORSAL HAND FLAP FOR COVERING IMPORTANT LONG FINGERS SKIN DEFECTS
F. Katrana, J. Bakhach, E. Demiri, B. Panconi and J. C. Guimberteau Institut Aquitain de la Main, 56 alle´e des Tulipes, Bordeaux-Pessac, France The digito-metacarpal dorsal flap described by Bakhach in 1999 is a cutaneous flap raised from the dorsal aspect of every inter-metacarpal space of the hand. Its irrigation is based on a retrograde flow through the dorsal intermetacarpal arteries. These arteries ended at each web space in terminal branches, which continue with the dorsolateral digits arterial networks and anastomoses with the first dorsal cutaneous branch of the corresponding palmar collateral artery. This constant anastomosis is situated at the level of the mid first phalanx which corresponds to the pivot point of the flap. These particular vascular communications between the dorsal hand network and the digital palmar collateral arteries offer a wide range of covering competence. With a cutaneous paddle designed on the dorsal aspect of the hand and a pivot point placed at the mid length of the first phalanx, the flap can easily reach the distal end of the long fingers. The operative technique of flap harvesting respects the Junctum Tendinosum on one side and lets free the MCP joint on the other. These conditions authorise to start an early digital physiotherapy. Our clinical experience comprises 40 flaps. All of them were carried out for the reconstruction of dorsal or lateral defects of the long fingers situated beyond the middle of the first phalanx. Eighty percent of the cases were a work accident. In 87% the patients were male. The distribution of the digital injuries was: Index finger 30%, third finger 37.5%, fourth finger 20% and fifth finger 12.5%. All our flaps were successful except for two cases where we faced
Background: Large and deep soft-tissue defects of the palm are not very frequent but their reconstruction can be difficult due to the special anatomy required. The ideal substitute must be durable, relatively immobile, hairless and thin. We are reporting our clinical experience using a gracilis free muscle for the reconstruction of the palm of the hand and thenar muscles. Patients and methods: We used the gracilis free muscle flap in five men for covering hand defect in crushing injuries (n ¼ 2), severe scar contracture (n ¼ 1), gun shot injury (n ¼ 1) and severe infection (n ¼ 1); the mean age was 42 years. The gracilis muscle was harvested from the uninjured side and split-thickness skin grafts was used to cover the transplant. In each case, after a radical debridement the anastomosis was easily placed outside the zone of injury on the ulnar (n ¼ 4) or radial (n ¼ 1) artery. End to side anastomosis was performed for all flaps. The motor branch of the gracilis flap was sutured to the motor branch of median nerve (n ¼ 1). The flaps were examined for appearance, mobility and adherence to the underlying tissues. Results: The mean follow-up is 12 months (6–36 months). The transplanted muscle provided excellent contour and durable cover in all five hands. There were no incidences of partial or complete flap loss. Intact deep pressure sensation was present in all the hand but flaps did not develop any sensibility. In three patients the flap was firmly adherent with very little mobility. One patient had slight mobility of his flap but not enough to produce a functional problem. In two patients the flap was darker than the surrounding skin because of the origin of the skin graft. There was no donor-site morbidity. Conclusion: In our experience, the free gracilis muscle flap transplantation provides very satisfactory results in the treatment of large palmar defects with no donor-site morbidity. This same flap can be used for the reconstruction of the thenar muscles and an appropriate opposition function. 10.1016/j.jhse.2007.02.161
reconstruction with a one stage operation, they always need a wide dissection, which may lead to volar scarring. The majority of these problems can be avoided with the use of the dorsal island homodigital flap. After debridement of the recipient area the length and width of the skin defect is measured and a flap is raised by making an incision across the dorsum of the digit 4 to 5 mm proximal to the eponychium between the two midlateral lines. It is based on the side of the proximal edge of the obliquity of the amputation stump and is islanded on a subcutaneous tissue pedicle that includes a dorsal artery and a nerve branch. From October 2005 to October 2006 the dorsal island homodigital flap was used in 12 patients and we are presenting our experience in the use of this flap.
59
a partial suffering of the flap extremity, occurring in smoker patients. The treatment consisted of surgical debridement and secondary healing without alteration of the final outcome. The donor site was either primarily closed with the adding of discharge incisions whenever necessary, or left to secondary healing when the width of the flap exceeded 2.5 cm. We never used skin graft. 10.1016/j.jhse.2007.02.160
A-0313 14.5 GRACILIS FREE MUSCLE FLAP FOR COVERAGE OF PALMAR DEFECTS
10.1016/j.jhse.2007.02.159
N. Chahidi, P. Lorea, A. Le Jeune and K. Drossos Clinique du Parc Le´opold Bruxelles, Belgium A-0330 14.4 THE DIGITO-METACARPAL DORSAL FLAP: A USEFUL DORSAL HAND FLAP FOR COVERING IMPORTANT LONG FINGERS SKIN DEFECTS
F. Katrana, J. Bakhach, E. Demiri, B. Panconi and J. C. Guimberteau Institut Aquitain de la Main, 56 alle´e des Tulipes, Bordeaux-Pessac, France The digito-metacarpal dorsal flap described by Bakhach in 1999 is a cutaneous flap raised from the dorsal aspect of every inter-metacarpal space of the hand. Its irrigation is based on a retrograde flow through the dorsal intermetacarpal arteries. These arteries ended at each web space in terminal branches, which continue with the dorsolateral digits arterial networks and anastomoses with the first dorsal cutaneous branch of the corresponding palmar collateral artery. This constant anastomosis is situated at the level of the mid first phalanx which corresponds to the pivot point of the flap. These particular vascular communications between the dorsal hand network and the digital palmar collateral arteries offer a wide range of covering competence. With a cutaneous paddle designed on the dorsal aspect of the hand and a pivot point placed at the mid length of the first phalanx, the flap can easily reach the distal end of the long fingers. The operative technique of flap harvesting respects the Junctum Tendinosum on one side and lets free the MCP joint on the other. These conditions authorise to start an early digital physiotherapy. Our clinical experience comprises 40 flaps. All of them were carried out for the reconstruction of dorsal or lateral defects of the long fingers situated beyond the middle of the first phalanx. Eighty percent of the cases were a work accident. In 87% the patients were male. The distribution of the digital injuries was: Index finger 30%, third finger 37.5%, fourth finger 20% and fifth finger 12.5%. All our flaps were successful except for two cases where we faced
Background: Large and deep soft-tissue defects of the palm are not very frequent but their reconstruction can be difficult due to the special anatomy required. The ideal substitute must be durable, relatively immobile, hairless and thin. We are reporting our clinical experience using a gracilis free muscle for the reconstruction of the palm of the hand and thenar muscles. Patients and methods: We used the gracilis free muscle flap in five men for covering hand defect in crushing injuries (n ¼ 2), severe scar contracture (n ¼ 1), gun shot injury (n ¼ 1) and severe infection (n ¼ 1); the mean age was 42 years. The gracilis muscle was harvested from the uninjured side and split-thickness skin grafts was used to cover the transplant. In each case, after a radical debridement the anastomosis was easily placed outside the zone of injury on the ulnar (n ¼ 4) or radial (n ¼ 1) artery. End to side anastomosis was performed for all flaps. The motor branch of the gracilis flap was sutured to the motor branch of median nerve (n ¼ 1). The flaps were examined for appearance, mobility and adherence to the underlying tissues. Results: The mean follow-up is 12 months (6–36 months). The transplanted muscle provided excellent contour and durable cover in all five hands. There were no incidences of partial or complete flap loss. Intact deep pressure sensation was present in all the hand but flaps did not develop any sensibility. In three patients the flap was firmly adherent with very little mobility. One patient had slight mobility of his flap but not enough to produce a functional problem. In two patients the flap was darker than the surrounding skin because of the origin of the skin graft. There was no donor-site morbidity. Conclusion: In our experience, the free gracilis muscle flap transplantation provides very satisfactory results in the treatment of large palmar defects with no donor-site morbidity. This same flap can be used for the reconstruction of the thenar muscles and an appropriate opposition function. 10.1016/j.jhse.2007.02.161