Composite Palmaris Longus-Venous Flap for Simultaneous Reconstruction of Extensor Tendon and Dorsal Surface Defects of the Hand???Long-Term Functional Result

Abstract

Soft tissue loss in the dorsum of the hand resulting from trauma often involves the extensor mechanism due to its thin skin coverage. When such composite skin and extensor tendon defects occur, the wound could be reconstructed with an ipsilateral forearm venous flap with accompanying palmaris longus tendon. Eighteen dorsal finger defects in 12 patients underwent composite venous flap and tendon transfers in the acute stage. We used both Buck-Gram-cko and Tubiana's methods for objective functional assessments. With the former method, the average composite flexion, extension deficit, and total active motion were 207.2 degrees, 39.0 degrees, and 164.7 degrees, respectively. The average score was 12.1 points, which qualified for a "good" result. With Tubiana's method, the average active flexion was 4.9, and the average extension defect was 2.3. The average score was 7.2 point, which also qualified for a "good" result. Thus, a one-stage composite forearm venous flap could be used to reconstruct dorsal skin and tendon defects of the finger with a predictably good functional outcome.

The palmaris longus muscle and its relations with the antebrachial fascia and the palmar aponeurosis

“…It has been used in the reconstruction of other tendons (Mountney et al, 1998;Lin et al, 2004;Unglaub et al, 2006;Chu et al, 2008), for frontalis suspension in the treatment of blepharoptosis (Kurihara et al, 1984;Lam et al, 1996;Park and Shin, 2008), as a substitute for ligaments in the stabilization of joints (Jackson and Saint Onge, 1977;Scheker and Ozer, 2004;Furukawa et al, 2007) or of the digital pulleys (Kaufmann and Pacek, 2006), and for the reconstruction of lip (Gürlek et al, 2005;Cinar et al, 2007) and eyelid defects (Ueda et al, 2007). The palmaris longus tendon is also used as a topographical landmark for surgery in the wrist area (Brones and Wilgis, 1978) and the muscle should be considered as a possible cause of ulnar or median nerve compression syndromes (Tiengo et al, 2006) or of forearm pseudo-masses when hypertrophied (Polesuk and Helms, 1998).…”

Reconstruction of Large Dorsal Digital Defects With Arterialized Venous Flaps

“…For the functional assessment with regard to the range of motion, inconsistent results were observed because of the uncertainty of the severity of the injuries and different assessment methods; however, satisfactory outcomes with more than 150 degrees of range of motion were recorded in those cases that underwent the reconstruction using composite AVFs. 3,10 As regard to the aesthetic outcomes of this procedure, all the studies that specifically documented these concerns reported good appearance at follow-up. 7,9,13Y17 The number of secondary revision was only recorded in several cases including DB procedure in 2, AD in 2, separation of syndactyly in 1, and tendolysis in 1, respectively.…”

“…Conventionally, these injuries are managed with primary soft tissue coverage followed by a later secondary tendon reconstruction. 3 In literature, local or regional flaps are often the preferred choice for soft tissue reconstruction of hand and digits 4 ; however, when facing larger dorsal defects, extensive and multiple digits injuries, these flaps are sometimes precluded and free flaps are frequently considered as the optimal options. 5 Free arterialized venous flaps (AVFs) with the advantages of thin, pliable, easy to elevate, and minimal donor-site morbidity have gained special popularity in the reconstruction of the dorsal finger defects despite of the concerns of inconsistent survival status.…”

“…6Y17 It can be harvested as either a pure cutaneous flap or a composite flap with palmaris longus tendon. 3,9Y13, 17 The purpose of this study was to present our experience of reconstruction of the large dorsal digital defects with the AVF and evaluate its merits and demerits in this clinical setting with a comprehensive review of literature.…”

Free Lateral Arm Flap for 1-Stage Reconstruction of Soft Tissue and Composite Defects of the Hand

“…Hence, the tissue fibrosis stimulated in the transected sites of the tendon and the inherent adherence of the tendon graft to the intermuscular septum may in turn cause limitation in excursion, suboptimal range of motion, or even stiffness of the traumatized fingers. Based on our previous experience, the functional results, including the tendon excursion, are superior in palmaris longus tendon in composite venous flaps 26 and radial forearm tendocutaneous flap, where the integrity of the tendon is largely preserved.…”