Free Dorsal Middle Phalangeal Finger Flap

Takeishi, Meisei; Ishida, Katsuhiko; Kurihara, Kunihiro

doi:10.1055/s-2006-951312

Cited by 11 publications

(8 citation statements)

References 7 publications

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“…The thin skin of the hand and fingers mandates the similar appraisal of donor characteristics. 14,15 Small defects may be best treated with small fasciocutaneous flaps such as a free first dorsal metacarpal artery from the opposite hand 16,17 or a medial plantar flap from the foot. 18,19 These small flaps were designed with the intent of replacing like with like tissue.…”

Section: Flap Selectionmentioning

confidence: 99%

“…These flaps oftentimes have improved color and contour match and can be taken as perforator flaps to decrease bulk and reduce donor-site morbidity. 17,[36][37][38][39][40][41] There is a limit, however, of how much tissue can be harvested from a cutaneous donor site and still obtain primary closure. For instance, the width of a lateral arm flap usually has a limit of 6 cm in diameter (Fig.…”

Section: Fasciocutaneous Flapsmentioning

confidence: 99%

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The Reconstruction of the Mutilated Hand

Neumeister

Hegge²,

Amalfi³

et al. 2010

Seminars in Plastic Surgery

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The challenging reconstructive treatment of defects in the upper extremity requires a sound working knowledge of a variety of flaps. As the hand surgeon weighs the pros and cons of each possible flap to obtain definitive closure, he or she must also integrate the priorities of function, contour, and stability as well as the anticipation of further reconstructive surgery in choosing the flap of choice. This review describes the various flaps available for closure of soft tissue defects of the upper extremity. The principles of management of wounds of the upper extremity is described to guide hand surgeons in the early treatment of massive wounds that will eventually need free tissue coverage. Currently used flaps include fasciocutaneous, fascial, musculocutaneous, muscle, and osteocutaneous flaps. Flap selection is based on the characteristics of the defect including size, shape, and location, the availability of donor sites, and the goals of reconstruction. Improved techniques of microsurgery and an ever increasing repertoire of flaps provide the framework for hand surgeons to offer the most appropriate flap based on donor site, thickness, amount of tissue needed, and composition. A discussion of the selection of ideal flaps for any given defect should enable the reconstructive hand surgeon to provide the most appropriate coverage of wounds to the hand and upper extremity.

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Section: Flap Selectionmentioning

confidence: 99%

Section: Fasciocutaneous Flapsmentioning

confidence: 99%

The Reconstruction of the Mutilated Hand

Neumeister

Hegge²,

Amalfi³

et al. 2010

Seminars in Plastic Surgery

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show abstract

“…Free tissue transfer without the use of general anesthesia has been described with epidural anesthesia [12][13][14] and peripheral block/regional anesthesia in the extremities, particularly the hand. [15][16][17][18] It is important to distinguish between epidural anesthesia and true peripheral anesthesia as there are controversial reports regarding the use of epidural anesthesia on free tissue transfer. Some studies suggest an increased risk of complications secondary to the decreased blood flow to the extremity while others found no such malefic.…”

Section: Discussionmentioning

confidence: 99%

Free Flap Scalp Reconstruction in a 91-Year-Old Patient under Local-Regional Anesthesia: Case Report and Review of the Literature

Carey

Watt

et al. 2012

J reconstr Microsurg

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In the elderly population with significant medical comorbidities, the safety of general anesthesia is often in question. In the head and neck, where regional and extradural anesthesia are not options, reconstruction of defects requiring free tissue transfer becomes a particular challenge for patients in whom general anesthesia is contraindicated. We present a case of a scalp reconstruction utilizing a latissimus dorsi free flap in a 91-year-old man performed entirely under local and regional anesthesia. General anesthesia was contraindicated secondary to the patient's multiple medical comorbidities. A paravertebral block was used for the harvest of the latissimus dorsi muscle and skin grafts. The microvascular portion of the procedure and the inset were performed under local anesthesia alone. The patient tolerated the procedure, and the operation was successful. This case is unique in that there are no published reports of head and neck free tissue transfer being performed entirely under local-regional anesthesia. We conclude that despite the medical challenges of performing complex reconstruction in elderly patients, expedient free tissue transfer can offer patients access to successful reconstruction.

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“…3,4,11,16,18,19,22,28,29 Although seemingly not a problem for some authors, other articles have focused on the well-recognized problem of venous congestion in reverse-flow intrinsic flaps of the hand. 8,[13][14][15] Strategies employed to overcome this problem include preservation and transfer of a cutaneous dorsal vein, microanastomosis of a dorsal vein, and even turning a common pedicle flap into a free flap to utilize a larger-caliber dorsal venous anastomosis. [13][14][15] In this series, the reverse-flow flaps suffered specifically this complication of venous congestion, leading to varying degrees of superficial epidermolysis, but no partial or complete full-thickness necrosis of the flap or other complications such as infection.…”

Section: Discussionmentioning

confidence: 99%

Specific Complications Associated with Different Types of Intrinsic Pedicle Flaps of the Hand

Henry¹

2008

J reconstr Microsurg

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One hundred eight pedicle flaps intrinsic to the hand were performed in 98 male and 10 female patients averaging 36 years of age for digit-level trauma in 19 thumbs, 27 index, 50 long, 8 ring, and 4 small fingers. Specific flaps employed were 79 antegrade proper digital artery, 10 reverse proper digital artery, 6 reverse second dorsal metacarpal artery, 5 antegrade first dorsal metacarpal artery, 6 reverse dorsal ulnar artery of thumb, and 2 dorsal middle phalangeal flaps. The final average total active motion in the fingers was 235 degrees. Complications in 42 cases (39% actively smoking) included 10 partial flap losses, 13 cases of superficial epidermolysis, 4 cases of venous congestion, 4 superficial infections, 3 deep infections, and 8 cases of delayed healing at the wound margin. Second surgeries required were 3 debridements of deep wound infections, 3 revisions of the distal fingertip, and 9 full-thickness skin grafts. Specific associations of complications with flap type were between antegrade proper digital artery flaps and partial flap loss, epidermolysis, delayed wound healing, and infections at the distal margin but no cases of venous congestion. Reverse-flow flaps experienced venous congestion and epidermolysis but no partial flap losses or infection.

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Free Dorsal Middle Phalangeal Finger Flap

Cited by 11 publications

References 7 publications

The Reconstruction of the Mutilated Hand

The Reconstruction of the Mutilated Hand

Free Flap Scalp Reconstruction in a 91-Year-Old Patient under Local-Regional Anesthesia: Case Report and Review of the Literature

Specific Complications Associated with Different Types of Intrinsic Pedicle Flaps of the Hand

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