Adipofascial, Transposition, and Rotation Flaps

Venkatramani, Hari; Varadharajan, Vigneswaran

doi:10.1016/j.hcl.2019.08.002

Cited by 6 publications

(3 citation statements)

References 19 publications

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“…In dorsal defects with the paratenon still present and in volar defects with adequate neurovascular, tendon and bone soft tissue coverage, a skin graft (STSG or FTSG) is still viable, but we should avoid using them in pulp defects because they decrease discriminative sensitivity ( 58 ). Finger defects excluding the fingertip can be covered by local adipofascial, rotator or transposition flaps, or especially dorsal defects by local propeller flaps such as the Quaba flap ( Figure 7 ) ( 59 , 60 ).…”

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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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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“…On the other hand, skin flaps are more useful than grafts on mobile areas, joints, and sphincters. They are considered superior because they do not cause secondary contracture, and they match the same colour and texture of the surroundings [9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Skin Graft Versus Local Flaps in Management of Post-burn Elbow Contracture

Issa¹,

Badawi²,

Bisheet³

et al. 2021

Cureus

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IntroductionContracture is a pathological scar tissue resulting from local skin tissue damage, secondary to different local factors. It can restrict joint mobility, resulting in deformity and disability. This study aimed to investigate the outcomes of skin grafts compared to local flaps to reconstruct post-burn elbow contractures. These parameters included regaining function, range of movement, recurrence, and local wound complications. MethodologyA retrospective study reviewed 21 patients for elbow reconstruction over 12 months. Only patients with post-burn elbow contracture were included. Other causes, including previous corrective surgery, associated elbow stiffness, and patients who opted out of post-operative physiotherapy, were excluded. Patients were categorized according to the method of coverage into three groups: graft alone (G1), local flap (G2), or combined approach (G3). ResultsFemales were three times at higher risk to suffer a burn injury, while almost half of the cases were children. Scald injury represented 81% of burn causes. G1,2,3 were used in 47.6%, 42.9% and 9.5% of cases retrospectively. The overall rate of infection was 28.6%. Hundred percent graft taken was recorded in 83.3 % of cases; however, flap take was 91.1%. After 12 months of follow-up, re-contracture was 60% and 22.8% in G1 and G2; however, the satisfaction rate was 70% and 100% in both groups retrospectively. The overall satisfaction was 85.7% in all groups. ConclusionGrafts and local flaps are reasonable options for post contracture release; however, flaps are superior. Coverage selection depends on the lost tissue area and exposure of underlying deep structures. Physiotherapy and patient satisfaction are crucial in the outcomes.

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“…Thus, the treatment of burn wounds near joints requires further attention. Skin grafts, which consist of a thin epidermal layer and a portion of the dermis without blood supply, more frequently lead to contracture than skin flaps, which have a blood supply source [9][10][11]. Before neovascularization from the wound bed to the skin graft, oxygen or nutrients are delivered to the skin graft through diffusion from the wound bed.…”

Section: Introductionmentioning

confidence: 99%

3D-Printed Auxetic Skin Scaffold for Decreasing Burn Wound Contractures at Joints

Park,

Kim,

Kim

et al. 2023

JFB

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For patients with severe burns that consist of contractures induced by fibrous scar tissue formation, a graft must adhere completely to the wound bed to enable wound healing and neovascularization. However, currently available grafts are insufficient for scar suppression owing to their nonuniform pressure distribution in the wound area. Therefore, considering the characteristics of human skin, which is omnidirectionally stretched via uniaxial stretching, we proposed an auxetic skin scaffold with a negative Poisson’s ratio (NPR) for tight adherence to the skin scaffold on the wound bed site. Briefly, a skin scaffold with the NPR effect was fabricated by creating a fine pattern through 3D printing. Electrospun layers were also added to improve adhesion to the wound bed. Fabricated skin scaffolds displayed NPR characteristics (−0.5 to −0.1) based on pulling simulation and experiment. Finger bending motion tests verified the decreased marginal forces (<50%) and deformation (<60%) of the NPR scaffold. In addition, the filling of human dermal fibroblasts in most areas (>95%) of the scaffold comprising rarely dead cells and their spindle-shaped morphologies revealed the high cytocompatibility of the developed scaffold. Overall, the developed skin scaffold may help reduce wound strictures in the joints of patients with burns as it exerts less pressure on the wound margin.

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Adipofascial, Transposition, and Rotation Flaps

Cited by 6 publications

References 19 publications

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

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

Skin Graft Versus Local Flaps in Management of Post-burn Elbow Contracture

3D-Printed Auxetic Skin Scaffold for Decreasing Burn Wound Contractures at Joints

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