Reconstruction of a Complex Defect of the Dorsum of the Hand

Tropet, Y.; Brientini, J.M.; Garbuio, P.; Ridoux, P. E.; Vichard, P

doi:10.1016/s0266-7681(05)80116-0

Cited by 8 publications

(9 citation statements)

References 11 publications

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“…Finalmente, otro de los clásicos inconvenientes de los colgajos musculares, es el exceso de volumen aportado y el pobre resultado estético. Sin embargo, este exceso de volumen se puede reducir fácilmente con el uso de presoterapia, logrando coberturas, evitando así, la necesidad de cirugías posteriores para adelgazar el colgajo 12,13 . El colgajo microquirúrgico del músculo gracilis constituye una excelente opción en los defectos en mano, tanto en dorso como en palma, permitiendo el deslizamiento de los …”

Section: Discussionunclassified

Colgajo microquirúrgico de músculo gracilis para cobertura de palma y dorso de mano tras revascularización

García-Bernal

Zayas

Regalado³

et al. 2015

Rev Iberoam Cir Mano

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Presentamos el caso de un varón de 28 años de edad que sufrió el atrapamiento y la avulsión cutánea de la palma y dorso de la mano izquierda con arrancamiento de todos los pedículos vasculo-nerviosos a la altura del canal carpiano. Presentaba una fractura metafisaria de la falange proximal del quinto dedo, fractura diafisaria del tercer metacarpiano y avulsión de la piel del pulgar a la altura de la articulación trapeciometacarpiana. Las fracturas se fijaron con agujas. Tras la revascularización del pulgar y reparación microquirúrgica de los pedículos avulsionados, el 5.° dedo y la piel de la palma y del dorso, evolucionaron a la necrosis. Una semana después se realizó el desbridamiento de la necrosis y la cobertura con un colgajo microvascular de músculo gracilis, anastomosado a la arteria cubital termino-lateralmente. Cinco días después el colgajo se cubrió con un injerto de piel de espesor parcial.El postoperatorio trascurrió sin complicaciones. El paciente comenzó la rehabilitación a la 4.a semana tras revascularización. 28 meses tras la intervención presenta un rango de movimiento de los dedos trifalángicos y muñeca completos, rigidez en pulgar (IF 30°-90°, MCF 20-60°). La sensibilidad era de 20 mm en el test de discriminación a los dos puntos en los dedos trifalángicos y, anestesia en el pulgar. La fuerza de prensa era del 79,6% (43 kg/54 kg) respecto a la mano sana.El colgajo microquirúrgico del músculo gracilis constituye una excelente opción para cobertura en mano, al permitir el deslizamiento de los tendones. Además, mediante el uso de presoterapia, se consigue un excelente resultado estético, en un único tiempo, muy superior al conseguido con colgajos fasciocutáneos.

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Section: Discussionunclassified

Colgajo microquirúrgico de músculo gracilis para cobertura de palma y dorso de mano tras revascularización

García-Bernal

Zayas

Regalado³

et al. 2015

Rev Iberoam Cir Mano

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“…Reconstruction of such extensive defects is usually accomplished through multiple stages, with primary skin cover by vascularized flaps followed by or combined with reconstruction of the deep structures (Scheker et al, 1993;Tropet et al, 1995;Wood, 1997). An alternative is the use of composite flaps that include multiple different vascularized tissue units in addition to the skin component.…”

Section: Discussionmentioning

confidence: 99%

Composite anterolateral thigh perforator flaps in the management of complex hand injuries

Meky

Safoury

2011

J Hand Surg Eur Vol

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The anterolateral thigh (ALT) fasciocutaneous flap has been well described for hand skin cover, however its use in its composite (multiple tissue) form incorporating bone, muscle and/or fascia has been less well described. We report the usefulness of the composite ALT flap in six complex hand trauma cases, four male and two female (age range 14-46 years). The palm of the hand was affected by injury in three cases, the dorsum in two cases, and the radial side in one case. The first web formed part of the injury in three cases. There was variable involvement of the tendons, nerves and bones. Fascia lata was included in the flap to provide a gliding surface in four cases, part of the vastus lateralis muscle was included to obliterate dead space in two cases and to create a first web in one case, and a bone block from the iliac crest was included to reconstruct the lost metacarpals in one case. All flaps survived with minimal complications. This work shows that the anterolateral thigh composite flap is a reliable option when multiple tissue types are required in hand reconstruction.

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“…2 Interventions for reconstruction are complex in nature and options available are discussed in the literature. 4,6 Similarly, outcomes in these injuries relate to the sum of the various injured elements and the interactions between the structural systems undergoing healing and recovery. 2 It is clearly apparent that the practice of resting ones arm on the open window sill of a motor vehicle carries great risk should the limb come into contact with an immovable object such as a sign post, another vehicle or the surface of the road in a roll-over accident.…”

Section: Discussionmentioning

confidence: 99%

Injury to Arms Protruding Through Vehicle Windows

2003

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Driving with an arm protruding through a window can result in limb threatening injury. A series of seven upper limb injuries sustained during motor vehicle accidents (MVAs) with a limb protruding from the vehicle window is described. The severity and complexity of these injuries are related to the ultimate functional recovery for the limb. This study serves to highlight the severity of injury and morbidity following these modalities of trauma, which although rarely fatal, carry extensive consequences and could be easily prevented with appropriate education programmes and legislation.

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Reconstruction of a Complex Defect of the Dorsum of the Hand

Cited by 8 publications

References 11 publications

Colgajo microquirúrgico de músculo gracilis para cobertura de palma y dorso de mano tras revascularización

Colgajo microquirúrgico de músculo gracilis para cobertura de palma y dorso de mano tras revascularización

Composite anterolateral thigh perforator flaps in the management of complex hand injuries

Injury to Arms Protruding Through Vehicle Windows

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