A Review and Meta-analysis of Adverse Events Related to Local Flap Reconstruction for Digital Soft Tissue Defects

Karjalainen, Teemu; Jokihaara, Jarkko

doi:10.1016/j.hcl.2019.08.009

Cited by 9 publications

(5 citation statements)

References 199 publications

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“…37,38 Karjalainen et al performed a meta-analysis of 6,693 local flaps used for soft-tissue reconstruction of the digits, reporting 225 of 359 total complications were due to vascular compromise, primarily involving the arterial anastamosis. 39 Further, soft-tissue upper extremity reconstruction with free flap coverage has previously been identified to have an arterial thrombosis and venous congestion rate of 5.0 and 8.0%, respectively. 40 Venous-based flaps used in softtissue repair of the hand have been reported to have a 94.2% survival rate.…”

Section: Discussionmentioning

confidence: 99%

Propeller Perforator Flaps Used for Hand and Digit Reconstruction: A Systematic Review

Bovill

Huffman

Cach

et al. 2024

Journal of Hand and Microsurgery

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Background Propeller perforator flaps (PPFs) have increased in popularity due to the freedom in design and ability to cover a variety of defects without sacrificing the major vessels. Present reports of PPFs for upper limb reconstruction have not provided guidance for hand reconstruction, specifically. This study aims to review the current literature and evaluate techniques for use of PPFs in hand reconstruction. Methods A comprehensive literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for articles published from 1991 to 2021. The database search was queried for records using appropriate Medical Subject Headings (MeSH) terms. Studies reporting PPFs were limited to English language and excluded lower extremity or upper extremity reconstruction not specific to defects in the hand or digits. Study characteristics, patient demographics, indications, preoperative testing, flap characteristics, flap survival, and complication rates were collected. Results Out of the initial 1,348 citations yielded, 71 underwent full-text review. Ultimately, 25 unique citations were included encompassing 12 retrospective reviews (48%), 3 prospective cohort studies (10%), and 10 case series (40%). In review, 525 patients underwent reconstruction with a total of 613 propeller flaps performed to repair defects of the hand, digits, or both with use of 18 unique flap types. Overall flap survival was 97.8%. Acute wounds accounted for 72.9% of performed reconstructions. The mean flap coverage was 14.7 cm2. Complications occurred in 19.8% of cases, with venous congestion and partial flap necrosis occurring in 5.5 and 6.5% of cases, respectively, leading to a flap failure rate of 2.1%. Conclusion PPFs are a reliable option for hand or digital reconstruction, allowing surgeons to cover a variety of defects without sacrificing local vasculature. Despite nearly a 20% reported complication rate, nearly all flaps with venous congestion and partial flap necrosis included in these articles resolved without the need for secondary intervention, retaining an excellent overall flap survival.

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Section: Discussionmentioning

confidence: 99%

Propeller Perforator Flaps Used for Hand and Digit Reconstruction: A Systematic Review

Bovill

Huffman

Cach

et al. 2024

Journal of Hand and Microsurgery

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“…Previously published systematic reviews of soft tissue defect reconstruction in the upper extremity focus on perforator-based propeller flaps, venous flaps, radial dysplasia reconstruction, medial plantar flap after sarcoma resection and adverse events after local digital flaps ( 18 - 23 ). There are some reconstruction algorithms published.…”

Section: Discussionmentioning

confidence: 99%

A treatment algorithm for reconstruction of soft tissue defects in the hand: a narrative review

Nordback,

Hakkarainen,

Mattila

2023

Ann Transl Med

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Background and Objective The hand is the highly specialized distal construct of the upper limb with complex and intricate anatomy. Soft tissue defects can compromise this and result in significant functional impairment. Choosing the optimal reconstructive modality is essential for the best functional recovery. The objective of this narrative review was to provide a treatment algorithm for soft tissue defects in the hand. Methods Relevant literature for the topic was searched from PubMed and Cochrane Database from year 1953 up till end of November 2022. Specified searches for randomized controlled trials, systematic reviews and reviews were performed. Key Content and Findings There are no randomized controlled trials published on this topic. There are six systematic reviews or meta-analyses published. Most of the literature still comprises on expert opinion and case reports with few previously proposed algorithms. Defect features, size, location and depth, patient related factors and available resources are the main determinants of the treatment strategy. In the hand, there are reasonable locoregional coverage options, but microsurgical options should be a routine alternative of the treatment repertoire. In the thumb and fingers, the reconstruction depends remarkably on injury extent. Conclusions Patient factors, surgical expertise, etiology, severity and goal of reconstruction will invariably have influence on the ultimate reconstruction performed, and algorithms may significantly help the surgical planning.

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“…The Littler flap has a low rate of vascular complications, <1%. [24][25][26] The arterial supply of the flap is based on a robust artery that will not usually cause deficient perfusion, but being an island flap the venous return is only through the comitant veins, which can be twisted or compressed when the flap is placed over the defect. Thus, venous congestion, although extremely rare, is the most common complication of the Littler flap reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…The most common and feared complication is compromising vascularization, as it is the case with all flaps used at hand level. The Littler flap has a low rate of vascular complications, <1% [24–26] . The arterial supply of the flap is based on a robust artery that will not usually cause deficient perfusion, but being an island flap the venous return is only through the comitant veins, which can be twisted or compressed when the flap is placed over the defect.…”

Section: Discussionmentioning

confidence: 99%

Utility of “reposition-flap” in the reconstruction of the avulsed thumb

et al. 2021

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Injuries that result in thumb amputation cause a loss of 50% of hand function. Microsurgical replantation remains the gold standard of thumb reconstruction techniques. The non-microsurgical technical variants of thumb reconstruction described so far aim to create a neo-thumb of adequate length, stable, opposable, sensitive, and last but not least esthetically pleasing appearance. Avulsion of the distal phalanx and the absence of the nail will determine a functional deficit but also an unesthetic appearance. When replantation is not possible or the patient refuses to “sacrifice” another anatomical region for thumb reconstruction, the “reposition-flap” technique can be used. Although often controversial, this surgical technique deserves proper attention and should be used in some cases. We studied a group of 32 patients with distal thumb amputations. In patients with amputations in zone II according to Tamai, with interphalangeal joint preservation, the thumb was reconstructed using “reposition-flap” with an O’Brien flap in 15 cases. In the remaining 17 cases where the amputation was at the level of the interphalangeal joint, we used the same technique, but the thumb neopulp was reconstructed with the Littler heterodigital neurovascular flap harvested from the ulnar border of the middle finger in 11 cases or radial border of the ring finger in 6 cases. The results were evaluated from a functional (Kapandji score), sensitive (2-point discrimination, Semmes-Weinstein test) but also esthetically (patient satisfaction) point of view. Donor site morbidity, cold intolerance, the presence of nail dystrophy, and bone resorbtion were also assessed. The disabilities of the arm, shoulder and hand score was evaluated for each patient. Although various surgical and microsurgical techniques for thumb reconstruction are described, when choosing the technique to use we must first consider patient's wishes. A well-informed patient will be able to make, with the surgeon, the best decision for him concerning the reconstruction option.

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A Review and Meta-analysis of Adverse Events Related to Local Flap Reconstruction for Digital Soft Tissue Defects

Cited by 9 publications

References 199 publications

Propeller Perforator Flaps Used for Hand and Digit Reconstruction: A Systematic Review

Propeller Perforator Flaps Used for Hand and Digit Reconstruction: A Systematic Review

A treatment algorithm for reconstruction of soft tissue defects in the hand: a narrative review

Utility of “reposition-flap” in the reconstruction of the avulsed thumb

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