Reconstruction of volar skin and soft tissue defects of the digits including the pulp: Experience with the free SUPBRA flap

Iwuagwu, Fortune C.; Orkar, Sam K.; Siddiqui, Aftab Ahmed

doi:10.1016/j.bjps.2014.08.064

Cited by 26 publications

(27 citation statements)

References 25 publications

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“…For example, clinicians may attempt to restore an aesthetic attribute or maintain gross manual dexterity. 21 As a result, depending on the type of amputation, clinicians may use skin flaps to cover the wound to minimize tissue necrosis, 22,23 replant the amputated tip, [24][25][26][27][28] or fit for a prosthetic device. 29 For certain cases in children, clinical intervention is often kept minimal with a focus on cleaning and dressing the wound.…”

Section: Clinical Cases Of Digit Regrowthmentioning

confidence: 99%

Looking Ahead to Engineering Epimorphic Regeneration of a Human Digit or Limb

Quijano

Lynch

Allan

et al. 2016

Tissue Engineering Part B: Reviews

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Approximately 2 million people have had limb amputations in the United States due to disease or injury, with more than 185,000 new amputations every year. The ability to promote epimorphic regeneration, or the regrowth of a biologically based digit or limb, would radically change the prognosis for amputees. This ambitious goal includes the regrowth of a large number of tissues that need to be properly assembled and patterned to create a fully functional structure. We have yet to even identify, let alone address, all the obstacles along the extended progression that limit epimorphic regeneration in humans. This review aims to present introductory fundamentals in epimorphic regeneration to facilitate design and conduct of research from a tissue engineering and regenerative medicine perspective. We describe the clinical scenario of human digit healing, featuring published reports of regenerative potential. We then broadly delineate the processes of epimorphic regeneration in nonmammalian systems and describe a few mammalian regeneration models. We give particular focus to the murine digit tip, which allows for comparative studies of regeneration-competent and regeneration-incompetent outcomes in the same animal. Finally, we describe a few forward-thinking opportunities for promoting epimorphic regeneration in humans.

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Section: Clinical Cases Of Digit Regrowthmentioning

confidence: 99%

Looking Ahead to Engineering Epimorphic Regeneration of a Human Digit or Limb

Quijano

Lynch

Allan

et al. 2016

Tissue Engineering Part B: Reviews

View full text Add to dashboard Cite

show abstract

“…Thenar free flaps also have similar skin properties to those of the volar side of the PIP joint and can be innervated by the palmar cutaneous branch of the median nerve, if necessary [4,12,19]. Moreover, relatively large flaps can be harvested.…”

Section: Discussionmentioning

confidence: 99%

“…Thenar free flaps are supplied by the superficial palmar branch of the radial artery. Before designing the flap, the radial artery was identified with a hand-held Doppler probe close to the styloid process [4,12]. From that location, the superficial palmar branch was traced to the scaphoid tubercle.…”

Section: Thenar Free Flapsmentioning

confidence: 99%

Arterial or venous free flaps for volar tissue defects of the proximal interphalangeal joint: A comparison of surgical outcomes

et al. 2020

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Background For volar soft tissue defects of the proximal interphalangeal (PIP) joint, free flaps are technically challenging, but have more esthetic and functional advantages than local or distant flaps. In this study, we compared the long-term surgical outcomes of arterial (hypothenar, thenar, or second toe plantar) and venous free flaps for volar defects of the PIP joint.Methods This was a single-center retrospective review of free flap coverage of volar defects between the distal interphalangeal and metacarpophalangeal joint from July 2010 to August 2019. Patients with severe crush injuries (degloving, tendon or bone defects, or comminuted/intra-articular fractures), thumb injuries, multiple-joint and finger injuries, dorsal soft tissue defects, and defects >6 cm in length were excluded from the study, as were those lost to follow-up within 6 months. Thirteen patients received arterial (hypothenar, thenar, or second toe plantar) free flaps and 12 received venous free flaps. Patients’ age, follow-up period, PIP joint active range of motion (ROM), extension lag, grip-strength ratio of the injured to the uninjured hand, and Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score were compared between the groups.Results Arterial free flaps showed significantly higher PIP joint active ROM (P=0.043) and lower extension lag (P=0.035) than venous free flaps. The differences in flexion, grip strength, and QuickDASH scores were not statistically significant.Conclusions The surgical outcomes of arterial free flaps were superior to those of venous free flaps for volar defects of the PIP joint.

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“…The development and refinement of new flaps, such as the dorsoradial perforator (DRAP), superficial palmar branch of the radial artery (SUPBRA), and medialis pedis free flaps, have allowed for a single stage fingertip reconstruction under regional anesthesia with minimal donor site scarring. These perforator flaps are innervated and can restore some sensory function, as well as preserving aesthetic outcomes including skin texture and color ( 69 , 75, 76 ). As supermicrosurgery becomes increasingly incorporated into the field of hand surgery, the introduction of additional flaps and improvement of current techniques may allow for flap reconstruction to completely restore digital function in cases where replantation is not possible.…”

Section: Current Applicationsmentioning

confidence: 99%

Supermicrosurgery: History, Applications, Training and the Future

2018

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Supermicrosurgery, a technique of dissection and anastomosis of small vessels ranging from 0.3 to 0.8 mm, has revolutionized the fields of lymphedema treatment and soft tissue reconstruction. The technique offers several distinct benefits to microsurgeons, including the ability to manipulate small vessels that were previously inaccessible, and to minimize donor-site morbidity by dissecting short pedicles in a suprafascial plane. Thus, supermicrosurgery has become increasingly popular in recent years, and its applications have greatly expanded since it was first introduced 20 years ago. While supermicrosurgery was originally developed for procedures involving salvage of the digit tip, the technique is now routinely used in a wide variety of microsurgical cases, including lymphovenous anastomoses, vascularized lymph node transfers and perforator-to-perforator anastomoses. With continued experimentation, standardization of supermicrosurgical training, and high quality studies focusing on the outcomes of these novel procedures, supermicrosurgery can become a routine and valuable component of every microsurgeon’s practice.

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Reconstruction of volar skin and soft tissue defects of the digits including the pulp: Experience with the free SUPBRA flap

Cited by 26 publications

References 25 publications

Looking Ahead to Engineering Epimorphic Regeneration of a Human Digit or Limb

Looking Ahead to Engineering Epimorphic Regeneration of a Human Digit or Limb

Arterial or venous free flaps for volar tissue defects of the proximal interphalangeal joint: A comparison of surgical outcomes

Supermicrosurgery: History, Applications, Training and the Future

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