Microsurgical Tissue Transfer in Complex Upper Extremity Trauma

Chen, Chao; Wang, Zeng Tao; Li, Hao; Liu, Lin Feng

doi:10.1016/j.cps.2020.06.013

Cited by 4 publications

(4 citation statements)

References 53 publications

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“…Relevant studies have shown that VAC technology features various advantages, such as promoting drainage of wound exudate and reducing bacterial culture medium in the wound, thus improving inflammatory response of patients on the wound. 22 As shown in the results of this study, patients with severe hand trauma treated with VAC combined with multiple flaps have lower levels of IL-8, TNF and LPS, indicating that the application of VAC combined with multiple flaps can significantly reduce the inflammatory response of patients.…”

Section: Discussionsupporting

confidence: 54%

Clinical study on vacuum assisted closure combined with multiple flaps in the treatment of severe hand trauma

Wang

Zhang²,

Sun³

et al. 2021

Pak J Med Sci

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Objectives: To investigate the effect and clinical value of the application of vacuum assisted closure (VAC) combined with multiple flaps in the treatment of severe hand trauma. Methods: A total of 100 patients with severe hand trauma admitted to Harrison International Peace Hospital from September 2015 to September 2020 were selected and randomly divided into two groups according to the randomized block method: the single flap repair group and the combined repair group, with 50 patients in each group. Patients in the single flap repair group underwent flap repair according to their condition, while those in the combined repair group were treated with VAC prior to flap repair. The range of motion and hand sensation scores were compared between the two groups, and their levels of interleukin-8 (IL-8), tumor necrosis factor (TNF) and lipopolysaccharide (LPS) were tested by enzyme-linked immunosorbent assay (ELIS). Moreover, the flap survival rate and the incidence of adverse events were recorded and compared between the two groups. Results: Compared with the single flap repair group, the combined repair group had higher range of motion and hand sensation score (p<0.05), lower levels of IL-8, TNF and LPS (p<0.05), higher flap survival rate (p<0.05), and lower incidence of adverse events (p<0.05). Conclusion: VAC combined with multiple flaps boasts significant trauma repair effect and preferable clinical application value in the treatment of patients with severe hand trauma, which is principally reflected in significantly improving the hand function of patients and remarkably alleviating the inflammatory response of patients. doi: https://doi.org/10.12669/pjms.38.1.4631 How to cite this:Wang Q, Zhang X, Sun W, Li H. Clinical study on vacuum assisted closure combined with multiple flaps in the treatment of severe hand trauma. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4631 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionsupporting

confidence: 54%

Clinical study on vacuum assisted closure combined with multiple flaps in the treatment of severe hand trauma

Wang

Zhang²,

Sun³

et al. 2021

Pak J Med Sci

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“…In our experience, although “sooner is better,” 21 adequate debridement of necrotic tissue and absence of any infectious process must be ensured before any closure. Any infection will lead to flap loss and jeopardize the outcomes of any reconstructive surgery.…”

Section: Multidisciplinary Approachmentioning

confidence: 85%

“…36 Given their versatility, free tissue transfers often provide the best ways to address the multiple configurations of forearm defects, for example, chimeric flaps, flow-through flaps, and composite flaps. 37 Anterolateral flaps and parascapular flaps are the authors' favorite options when a large zone of thin and pliable skin is necessary (Fig. 6).…”

Section: Reconstructionmentioning

confidence: 99%

Management of Complex Forearm Injuries

et al. 2023

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The management of complex forearm injuries is challenging, not only because of the anatomical complexity of the region but also because of the dramatic functional consequences of these injuries. Preservation of the upper limb and restoration of hand function are the focus of the surgical management of these injuries. Decision making will consider several parameters such as the type of injury, the patient, the moment of reconstruction, the debridement, and the options available for reconstruction.A multidisciplinary approach joining plastic surgeons and orthopedic surgeons in a team effort is essential to achieve the best outcomes. On the basis of their experience, the authors conclude that the keystone in complex forearm injuries management is represented by a careful assessment of the lesions, an aggressive and early debridement, the prevention of complications such as infection and compartment syndrome, and an "as early as possible" reconstruction.

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“…Most of them include both elective free flap and replantation from multi-centered patient groups and did not make a direct comparison with corresponding adult groups [4]. Those studies narrowed down to trauma, and failed to focus specifically on hand defects [1,3,[5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Microsurgical reconstruction for traumatic hand defects in pediatric patients

Roh

Lee

Koh

et al. 2022

Arch Hand Microsurg

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Purpose: Microsurgery in pediatric patients remains challenging because of technical difficulties in small-vessel anastomosis and flap dissection. Few reports have focused exclusively on the microsurgical reconstruction of traumatic hand defects in children. Herein, we share our experience of posttraumatic hand reconstruction with free tissue transfer in pediatric patients and compare the treatment outcomes with adults.Methods: A single-institution retrospective review of trauma-induced microsurgical hand reconstruction cases was performed. Pediatric patients below 17 years old and adults who underwent microsurgical reconstruction of traumatic hand defects between 2011 and 2021 were included. Patient demographics, flap type, use of vein grafts, operative time, flap survival, and postoperative complications were documented. A subgroup analysis of patients younger than 8 years was also performed. Data of pediatric patients were statistically compared with those of adults who underwent free flap surgery using nearly identical surgical procedures by four senior surgeons at our medical center.Results: Forty-one flaps in 39 pediatric patients and 184 flaps in 184 adult patients were analyzed. Fasciocutaneous flaps were predominantly used in both groups. In pediatric patients, all flaps survived, while 170 adults (92.4%) survived. No statistically significant between-group differences in treatment outcomes were found. However, pediatric patients (22.0%) had significantly fewer secondary operations than adults (67.4%, p<0.001).Conclusion: Microsurgical reconstruction for trauma-induced hand defects in pediatric patients has a high success rate and low complication rate, just as with adults. Pediatric patients may be more resistant to partial necrotic flap changes, thereby requiring fewer secondary operations than adults.

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Microsurgical Tissue Transfer in Complex Upper Extremity Trauma

Cited by 4 publications

References 53 publications

Clinical study on vacuum assisted closure combined with multiple flaps in the treatment of severe hand trauma

Clinical study on vacuum assisted closure combined with multiple flaps in the treatment of severe hand trauma

Management of Complex Forearm Injuries

Microsurgical reconstruction for traumatic hand defects in pediatric patients

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