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One-stage repair of both skin and tendon digital defects using the arterialized venous flap with palmaris longus tendon
FREE COMPOSITE
TISSUE TRANSFERS
(cont.) AND VASCULAR
FREE COMPOSITE TISSUE TRANSFERS AND VASCULAR DISORDERS
DISORDERS
(cont.)
Experience with lateral arm flap in hand and forearm defects N. Cerkeg, M. Topalan, M. Erer, H. Agir Istanbul University, Istanbul Medical Hand Surgery, Istanbul, Turkey
School, Department
of
The lateral arm flap is currently one of the most frequently used free tissues. Easy dissection, constant anatomy and a long pedicle are the major advantages of this hap. 21 patients who had an upper extremity reconstruction with the lateral arm free flap are reviewed. The aetiology of the defects was electrical burn in 12 patients, thermal burn in 3 patients and trauma in 6 patients. The flap was transferred for distal forearm defects in 15 cases and for distal and volar soft tissue defects of hand in 6 cases.In 19 casesout of 2 1, the flaps were harvested from the ipsilateral limb. In 8 casesthe transfers were performed under axillary block anesthesia. All transfers were successfuland 4 casesrequired secondary thinning of flaps. In this presentation, indications and results with lateral arm flap will be discussed.
3
in skeletal microsurgical reconstruction. When it is used to reconstruct bone defects created by oncological resections involving the epiphysis of a growing child, the graft should include the fibular head in order to preserve the growth potential of the transplanted bone. Different techniques have been described to harvest a fibular autograft mantaining the blood supply to the proximal growth plate. According to Taylor’s anatomical findings the anterior tibia1 artery is supposed to be a reliable pedicle in order to vascularize both the fibular head and the proximal two-thirds of the shaft. Four children underwent surgery in the last 2 years; the resected bones have been the proximal humerus in three cases and the distal radius in one case. Two patients were affected by Ewing’s sarcoma and two by osteo-sarcoma. The follow-up ranges between 8 and 26 months. Function and growth rate of the transplanted bones are reported. No major complications at the donor site were observed. Pre- and postoperative chemotherapy was received by all patients.
Conventional autografts versus vascularized fibula humerus diaphyseal reconstruction for bone tumors One-stage repair of both skin and tendon digital defects using the arterialized venous flap with palmaris longus tendon G. Inoue Nagoya University School of Medicine, Nagoya, Japan
The combined loss of skin and tendon of the fingers is not uncommon and is a challenging problem. In the past, these injuries have been managed with a regional or distant flap, with tendon grafting done as a secondary procedure. This technique involves a multiple procedure usually requiring considerable time. The arterialized venous flap is now a routine procedure in our clinic to resurface skin defects of the hand and we considered that, if a palmaris longus tendon were taken as a composite unit, this might provide a potential donor graft. We have undertaken 6 arterialized venous flaps with a palmaris longus tendon, each having a minimum follow-up period of 6 months. Recipient sites were the dorsum of the PIP joint of the digit in 3, the dorsum of the DIP joint in 2 and the palmar aspect at the middle phalangeal level in 1. 4 flaps survived completely and 2 flaps survived with marginal necrosis. 2 patients involving loss of extensor slip and skin at the PIP joint had almost full range of motion of the PIP joint but the remaining 4 patients failed to achieve functional motion at the involved joint.
VFT in upper limb skeletal reconstruction cularized growth plate M. Innocenti, M. Ceruso, R. Angeloni, Capanna, M. Manfrini, Centro Traumatologico
with vas-
G. Lauri,
R.
Ortopedico, Fiuenze, Italy
VFT is probably the most popular and effective procedure
M. Ceruso, R. Capanna”, M. Innocenti, G. Lauri
M. Manfrini”,
in
R. Angeloni,
Centro Traumatologico Outopedico, Firenze, *Istituto pedico Rizzoli, Bologna, Italy
Orto-
The upper extremity is affected by bone and soft tissue neoplasms one-third as often as the lower extremity. Most tumors in the humerus occur in the proximal periarticular region while diaphyseal tumors are especially rare: very few reports in fact are available in the literature comparing the different techniques applicable in this location. The authors report their experience over 15 years in intercalary reconstructions of the humerus after bone sarcoma resection comparing vascularized fibula autograft and conventional autografts. Between 1978 and 1992 thirteen patients with diaphyseal malignant bone tumors of the humerus were treated by resection and intercalary reconstruction by means of autografts (8 patients) or vascularized fibular grafts (5 patients). Both groups presented a satisfactory outcome (92% good or excellent functional results) with no evidence of donor site morbidity. We have compared the indications and results and have found that a diaphyseal humeral defect shorter than 12 ems may be effectively treated by autogenous bone graft: this is usually achieved by a combination of tibia1 cortical struts, fibular nonvascularized grafts and iliac crest grafts. These invariably demand rigid fixation by long plates which may be required to be placed quite proximally in the humeral epiphysis and thus interfere with shoulder function. A vascularized fibular graft to bridge bony defects in the humeral shaft has been preferred in the following situations: a) if a very long diaphyseal resection is required for tumor excision or the resection needs to be extended either proximally or distally leaving small periarticular fragments. In these cases a VFG is preferred because its time to union is much shorter than a conventional graft and, therefore, the osteotomy can be internally fixed with a minimal amount of osteosynthesis.
TISSUE TRANSFERS
(cont.) AND VASCULAR
FREE COMPOSITE TISSUE TRANSFERS AND VASCULAR DISORDERS
DISORDERS
(cont.)
Experience with lateral arm flap in hand and forearm defects N. Cerkeg, M. Topalan, M. Erer, H. Agir Istanbul University, Istanbul Medical Hand Surgery, Istanbul, Turkey
School, Department
of
The lateral arm flap is currently one of the most frequently used free tissues. Easy dissection, constant anatomy and a long pedicle are the major advantages of this hap. 21 patients who had an upper extremity reconstruction with the lateral arm free flap are reviewed. The aetiology of the defects was electrical burn in 12 patients, thermal burn in 3 patients and trauma in 6 patients. The flap was transferred for distal forearm defects in 15 cases and for distal and volar soft tissue defects of hand in 6 cases.In 19 casesout of 2 1, the flaps were harvested from the ipsilateral limb. In 8 casesthe transfers were performed under axillary block anesthesia. All transfers were successfuland 4 casesrequired secondary thinning of flaps. In this presentation, indications and results with lateral arm flap will be discussed.
3
in skeletal microsurgical reconstruction. When it is used to reconstruct bone defects created by oncological resections involving the epiphysis of a growing child, the graft should include the fibular head in order to preserve the growth potential of the transplanted bone. Different techniques have been described to harvest a fibular autograft mantaining the blood supply to the proximal growth plate. According to Taylor’s anatomical findings the anterior tibia1 artery is supposed to be a reliable pedicle in order to vascularize both the fibular head and the proximal two-thirds of the shaft. Four children underwent surgery in the last 2 years; the resected bones have been the proximal humerus in three cases and the distal radius in one case. Two patients were affected by Ewing’s sarcoma and two by osteo-sarcoma. The follow-up ranges between 8 and 26 months. Function and growth rate of the transplanted bones are reported. No major complications at the donor site were observed. Pre- and postoperative chemotherapy was received by all patients.
Conventional autografts versus vascularized fibula humerus diaphyseal reconstruction for bone tumors One-stage repair of both skin and tendon digital defects using the arterialized venous flap with palmaris longus tendon G. Inoue Nagoya University School of Medicine, Nagoya, Japan
The combined loss of skin and tendon of the fingers is not uncommon and is a challenging problem. In the past, these injuries have been managed with a regional or distant flap, with tendon grafting done as a secondary procedure. This technique involves a multiple procedure usually requiring considerable time. The arterialized venous flap is now a routine procedure in our clinic to resurface skin defects of the hand and we considered that, if a palmaris longus tendon were taken as a composite unit, this might provide a potential donor graft. We have undertaken 6 arterialized venous flaps with a palmaris longus tendon, each having a minimum follow-up period of 6 months. Recipient sites were the dorsum of the PIP joint of the digit in 3, the dorsum of the DIP joint in 2 and the palmar aspect at the middle phalangeal level in 1. 4 flaps survived completely and 2 flaps survived with marginal necrosis. 2 patients involving loss of extensor slip and skin at the PIP joint had almost full range of motion of the PIP joint but the remaining 4 patients failed to achieve functional motion at the involved joint.
VFT in upper limb skeletal reconstruction cularized growth plate M. Innocenti, M. Ceruso, R. Angeloni, Capanna, M. Manfrini, Centro Traumatologico
with vas-
G. Lauri,
R.
Ortopedico, Fiuenze, Italy
VFT is probably the most popular and effective procedure
M. Ceruso, R. Capanna”, M. Innocenti, G. Lauri
M. Manfrini”,
in
R. Angeloni,
Centro Traumatologico Outopedico, Firenze, *Istituto pedico Rizzoli, Bologna, Italy
Orto-
The upper extremity is affected by bone and soft tissue neoplasms one-third as often as the lower extremity. Most tumors in the humerus occur in the proximal periarticular region while diaphyseal tumors are especially rare: very few reports in fact are available in the literature comparing the different techniques applicable in this location. The authors report their experience over 15 years in intercalary reconstructions of the humerus after bone sarcoma resection comparing vascularized fibula autograft and conventional autografts. Between 1978 and 1992 thirteen patients with diaphyseal malignant bone tumors of the humerus were treated by resection and intercalary reconstruction by means of autografts (8 patients) or vascularized fibular grafts (5 patients). Both groups presented a satisfactory outcome (92% good or excellent functional results) with no evidence of donor site morbidity. We have compared the indications and results and have found that a diaphyseal humeral defect shorter than 12 ems may be effectively treated by autogenous bone graft: this is usually achieved by a combination of tibia1 cortical struts, fibular nonvascularized grafts and iliac crest grafts. These invariably demand rigid fixation by long plates which may be required to be placed quite proximally in the humeral epiphysis and thus interfere with shoulder function. A vascularized fibular graft to bridge bony defects in the humeral shaft has been preferred in the following situations: a) if a very long diaphyseal resection is required for tumor excision or the resection needs to be extended either proximally or distally leaving small periarticular fragments. In these cases a VFG is preferred because its time to union is much shorter than a conventional graft and, therefore, the osteotomy can be internally fixed with a minimal amount of osteosynthesis.