Reconstruction of dorsal and palmar defects of hand with anterolateral thigh flaps from one donor site

Zhang, Guangliang; Su, Hao; Ju, Jihui; Li, Xiangjun; Fu, Yi; Hou, Ruixing

doi:10.1016/j.bjps.2019.08.002

Cited by 7 publications

(10 citation statements)

References 12 publications

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“…As a result, 7 papers remained and were included in our review ( Figure 1 ). All included papers were retrospective studies, and six were case series 9 - 13 . One study was comparative comparing the standard ALT with a sandwich ALT (sALT) technique 14 .…”

Section: Resultsmentioning

confidence: 99%

“…Otherwise, defects were also reported post-necrotising fasciitis debridement (1 patient) and oncological surgery (2 patients) 9 . Two studies reported associated injuries in combination with the soft tissue damage 9 , 13 . The follow up of the included participants ranged from 7 to 72 months ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Chen scoring, which is a four-grade system assessing functionality according to the ability to resume original work, joint motion, sensitivity and muscle power 16 was used in 2 studies 9 , 11 . Seven patients had Chen II grades, and ten patients had Chen I. Michigan Hand Questionnaire Scoring (MHQ) assesses hands’ functionality based on six scales (scored from 0-100, of which 100 is the best possible ability) 17 was used for assessment in only one study 13 . Lastly, the Upper Extremity Functional Scale (UEFS), which consists of 20 items (from zero to 4) with a score range from 0 to 80 18 was also used in one study only 13 .…”

Section: Resultsmentioning

confidence: 99%

“…Seven patients had Chen II grades, and ten patients had Chen I. Michigan Hand Questionnaire Scoring (MHQ) assesses hands’ functionality based on six scales (scored from 0-100, of which 100 is the best possible ability) 17 was used for assessment in only one study 13 . Lastly, the Upper Extremity Functional Scale (UEFS), which consists of 20 items (from zero to 4) with a score range from 0 to 80 18 was also used in one study only 13 . UFES scores resulted in 60.25 (+/-3.8) with standard ALT and 70.75 (+/-3.6) with sALT ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

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Functional and Aesthetic Outcomes of the Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects: A Systematic Review

Hagiga

Aly²,

Kadhum³

et al. 2022

WJPS

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Background: Soft tissue coverage in the upper limb after trauma, burn injury, or tumour removal is a commonly addressed problem by the plastic surgeon. The anterolateral thigh flap (ALT) is recognized as a popular free flap option for covering various types of soft tissue defects due to its versatility. We aimed to assess the functional and aesthetic outcomes of the ALT flap for reconstruction of upper limb defects. Methods: Four electronic databases were searched (MEDLINE (PubMed), Scopus, Web of Science, and Cochrane) from inception to Feb 2021. Two reviewers independently extracted the data and performed risk assessment using the modified Downs and Black (MDB) quality assessment tool and the modified Newcastle Ottawa Scale for case series. Results: This review included seven studies for quantitative assessment. The eligible studies had 67 patients. Included studies had used a varied number of validated upper extremity functional scoring systems; the most commonly used score was QuickDASH with mean of 21.24, DASH score was 15.5. In regard to aesthetic outcome, an overall satisfactory result was reported. A secondary debulking procedure was performed in 7 patients. Conclusion: Further studies are recommended to ascertain the functional and aesthetic outcomes of the ALT free flap for upper limb defects, especially using standardized outcome scoring systems. This may be supplemented with a questionnaire that addresses common patient concerns (such as colour, contour, textile and hair growth) for the aesthetic outcome. Nevertheless, based on our review, the ALT flap may be a good reliable reconstructive option for upper limb defects with good functional outcome and satisfactory aesthetic results.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Functional and Aesthetic Outcomes of the Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects: A Systematic Review

Hagiga

Aly²,

Kadhum³

et al. 2022

WJPS

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“…The main disadvantages are mandatory arm immobilization for 3 weeks and that the procedure has to be carried out in two stages 22 . With the development of microsurgery, the application of free flaps in hand reconstruction, particularly for large and composite defects is gradually increasing 36 . Anterolateral thigh flap, tensor fasciae latae flap, lateral arm flap, paraumbilical perforator flap and latissimus dorsi flap are mostly used 37 .…”

Section: Discussionmentioning

confidence: 99%

Versatile clinical application of radial artery perforator flap for hand and wrist reconstruction

et al. 2023

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Background/Aim. Radial artery perforator flap (RAPF) as a type of fasciocutaneous or adipofascial reverse pedicle flap, proved to be a versatile flap for reconstruction of small and moderate size soft tissue defects of the forearm, wrist, and hand. It provides suitable skin coverage with elastic subcutaneous tissue to protect exposed or damaged functional structures. The aim of this study is to summarize and analyse the results of the treatment of our patients with upper extremity soft tissue defects caused by trauma, infection, burn or tumour removal which were reconstructed with RAPF. Methods. This retrospective study includes 20 consecutive patients with skin and soft tissue defects of the hand and wrist, treated in the University Clinical Centre of Vojvodina from 2012 to 2022. Design of the flaps and length of the pedicles were determined by the recipient site. Tourniquet induced exsanguination was used during surgery for better visualization. The flaps were elevated and placed at the site of the defect. Patient and flaps? data were summarized upon their collection. Results. Distally based radial artery fasciocutaneous perforator flaps were used in all of the cases. The average age of the patients was 48 years, mostly males (64%). Defects were most often localized on the dorsal part of the hand (60%) and wrist (20%). The most common indications for surgery were trauma (45%) and tumour resection (25%). A satisfactory coverage of the defect was achieved in all 20 patients with no flap loss. Venous congestion was noted in 4 patients (20%) which resulted in partial necrosis of the flap in 3 patients (15%). Wound healing was achieved upon conservative treatment by secondary intention in two patients and with secondary suture in the last one. A surgical site infection occurred in 2 patients (10%) which withdrew after proper local and systemic therapy. Conclusion. Radial artery perforator flap proved to be a workhorse flap for soft tissue reconstruction of the upper limb. This surgical solution led to an excellent functional and aesthetic outcome in the majority of patients. Complex surgical procedures could be done simultaneously, together with reconstruction of tendons, joints, or fracture stabilisation. The reliability and safety of this flaps is confirmed through our clinical data.

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Multiple digit resurfacing with a lateral thoracic free flap: Two‐stage mitten hand and division procedures

Ryoo

Park

et al. 2023

Microsurgery

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PurposeThe conventional abdominal and groin flaps for resurfacing the defect have several disadvantages, including the risk of flap failure due to accidental traction or detachment, immobilization of the arm before division, and aesthetic dissatisfaction because of the flap bulkiness. The aim of this study was to share our experiences with the free lateral thoracic flap and elucidate the optimal timing of division in complex hand reconstruction, which yielded favorable outcomes in terms of both functionality and aesthetics.MethodsThis article is a retrospective review of multiple digit resurfacing using free tissue transfer from 2012 to 2022. Patients who underwent two‐stage operation including mitten hand creation using superthin thoracodorsal artery perforator (TDAp) free flap and secondary division were included. A flap was elevated over the superficial fascia layer the midportion between the anterior border of the latissimus dorsi and pectoralis major muscles and once the pedicle was found, an outline that matched the defect was created. A process named “pushing with pressure and cutting” was carried out before pedicle ligation until all the superficial fat tissue had been removed except for around the perforator. Two cases (18%) involved defects of the entire fingers reconstructed by TDAp flap with anterolateral thigh flap. Six cases (55%) had a super‐thin TDAp flap only. In two cases (18%), non‐vascularized iliac bone grafting was required for finger lengthening. One case (9%) was resurfaced with a TDAp chimeric flap including a skin paddle with the serratus anterior muscle. The primary outcome was defined as the survival or failure of the flap, while the secondary outcomes associated complications such as infection and partial flap necrosis. A statistical analysis was not performed due to the size of the case series.ResultsAll 13 flaps survived completely without any complications. Flap dimension ranged from 12 cm × 7 cm to 30 cm × 15 cm. Mitten hand duration prior to division was 41.9 days on average which was essential for the optimal result. During the division procedures, there were nine cases of debulking (82%), six cases of split‐thickness skin graft (STSG) (55%), and three cases of Z‐plasty performed on the first web space (27%). The mean follow‐up period was 20.2 months. Mean Disability of the Arm, Shoulder, and Hand (DASH) Questionnaire score was 10.76.ConclusionsWe resurfaced severe soft tissue defects of multiple fingers with thin to super‐thin free flaps, mainly TDAp flaps. Surgeons can restore original hand shape using a two‐stage reconstructive strategy of mitten hand creation and proper division timing to create a 3‐dimensional hand structure, even in severely injured hands with multiple soft tissue defects of the digits.

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Reconstruction of dorsal and palmar defects of hand with anterolateral thigh flaps from one donor site

Cited by 7 publications

References 12 publications

Functional and Aesthetic Outcomes of the Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects: A Systematic Review

Functional and Aesthetic Outcomes of the Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects: A Systematic Review

Versatile clinical application of radial artery perforator flap for hand and wrist reconstruction

Multiple digit resurfacing with a lateral thoracic free flap: Two‐stage mitten hand and division procedures

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