A bilobed groin flap for coverage of traumatic injury to both the volar and dorsal hand surfaces

Abstract

BACKGROUND: There are many methods available for coverage of both the volar and dorsal hand surfaces in traumatic injury. All of these surgical procedures allow for ample coverage of the defect, but have the major drawback of needing multiple donor sites. In the present report, a case of a complex crush injury to the hand in which both volar and dorsal surfaces received traumatic injury is presented. A bilobed groin flap pedicled on the superficial circumflex iliac artery was fashioned to cover the entire defect. Like many other described flaps, the bilobed groin flap resulted in a favourable functional and cosmetic result for the patient, but with the unique advantage of requiring a single donor site. METHODS: A bipedicled groin flap was raised from distal to proximal, and the flaps inset onto both the dorsal and volar hand defects. RESULTS: The patient regained adequate function of his hand, and was able to return to work full-time as a manual labourer. CONCLUSION: The bilobed groin flap appears to be a valuable option for covering complex hand injuries involving both the volar and dorsal surfaces of the hand.

The combined ALT–groin flap for the mutilated and degloved hand

“…However, this flap will not cover extensive dorsal and volar hand defects, particularly without time-consuming delay procedures or tissue expansion [8]. Extensive tissue loss warrants multiple-flap reconstruction [9,10,12,14,15,17,18]. The pedicled ALT flap was not described in hand reconstruction before this decade [21,23].…”

“…However, they may not cover extensive defects that involve the dorsal and palmar hand, particularly without a time-consuming delay procedure or tissue expansion [8]. Paired groin and abdomen flaps have been described since the 1970s [2,5,[9][10][11][12][13][14][15][16][17][18], which are better suited to extensive and three-dimensional wounds.…”

Groin Flap Experience in the Reconstruction of Soft Tissue Defects of the Hand

“…The groin flap, supplied by the superficial circumflex iliac artery system, was defined by McGregor and Jackson in 1972. 1,[9][10][11][12] Free groin flap was first used in 1973 by Daniel and Taylor. 13 Pedicled groin flap is frequently used in the same hand and upper extremity defects.…”

“…Bilobed groin flap was described in correcting the hand in Apert syndrome and in closing the defect that formed after opening the thumb contracture. 1,20,21 Further, bilobed groin flap is described in the literature for the reconstruction of defects secondary to trauma on the dorsal and volar surfaces of the hand. 1 Tan et al 5 reported reconstructing a defect spanning both of the two digits on the second web space with a winged groin flap.…”

“…Various pedicled and free flaps are described in the literature for closing these kinds of defects. [1][2][3] Pedicled groin flap has long been playing an important role in reconstructive hand surgery. This flap is a reliable method for closing the defects, particularly in dorsal hand injuries, and for closing the soft tissue defects of the hand 4,5 and is used in many clinical conditions.…”