Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity

Ng, Zhi Yang; Tan, Shaun; Lellouch, Alexandre G.; Cetrulo, Curtis L.; Chim, Harvey

doi:10.5999/aps.2017.44.2.117

Cited by 11 publications

(8 citation statements)

References 40 publications

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“…The reconstructive algorithms exist for specific regions of upper limb 5 , 6 or general management of upper limb trauma. 7 , 8 A general algorithm encompassing the whole of upper limb reconstruction with pedicle flaps is helpful in day to day practice.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of post-traumatic upper extremity soft tissue defects with pedicled flaps: An algorithmic approach to clinical decision making

Naalla

Chauhan

Dave

et al. 2018

Chinese Journal of Traumatology

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PurposePedicled flaps are still the workhorse flaps for reconstruction of upper limb soft tissue defects in many centers across the world. They are lifeboat options for coverage in vessel deplete wounds. In spite of their popularity existing algorithms are limited to a particular region of upper limb; a general algorithm involving entire upper limb which helps in clinical decision making is lacking. We attempt to propose one for the day to day clinical practice.MethodsA retrospective analysis of patients who underwent pedicled flaps for coverage of post-traumatic upper extremity (arm, elbow, forearm, wrist & hand) soft tissue defects within the period of January 2016 to October 2017 was performed. Patients were divided into groups according to the anatomical location of the defects. The flaps performed for different anatomical regions were enlisted. Demographic data and complications were recorded. An algorithm was proposed based on our experience, with a particular emphasis made to approach to clinical decision making.ResultsTwo hundred and twelve patients were included in the study. Mean age was 27.3 years (range: 1–80 years), 180 were male, and 32 were female. Overall flap success rate was 98%, the following complications were noted marginal flap necrosis requiring no additional procedure other than local wound care in 32 patients (15%), partial flap necrosis requiring flap advancement or extra flap in 15 patients (7%), surgical site infection in 11 patients (5%), flap dehiscence requiring re-suturing in 5 patients (2.4%), total flap necrosis 4 patients (2%).ConclusionThe proposed algorithm allows a reliable and consistent method for addressing diverse soft tissue defects in the upper limb with high success rate.

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Section: Introductionmentioning

confidence: 99%

Reconstruction of post-traumatic upper extremity soft tissue defects with pedicled flaps: An algorithmic approach to clinical decision making

Naalla

Chauhan

Dave

et al. 2018

Chinese Journal of Traumatology

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“…The use of free flaps can lead to hand ischemia if thrombosis occurs [ 11 ]. However, some authors prefer the use of free flaps because a burned hand is prone to stiffness and free flaps allow an early mobilization [ 27 ]. The coverage of metacarpal heads is another described indication [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Upper limb traumatic injuries: A concise overview of reconstructive options

Starnoni

Benanti

Acciaro

et al. 2021

Annals of Medicine &Amp; Surgery

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Different options for upper limb reconstruction are described in literature: advancement or rotation flaps, regional flaps and free flaps are the most common. Local and regional flaps can represent the reconstructive options for small defects while large wounds require the use of free flaps or distant pedicled flaps. In case of large wound, the use of free flaps rather than distant pedicle flaps is usually preferred. To choose the best reconstructive option, it is essential for the surgeon to have a general overview about the different methods. In this review the Authors will refer to the most commonly used methods to cover soft tissues injuries affecting the dorsum and the palm of the hand and the forearm (excluding fingers). The aim is to show all flap reconstructive options so as to support the inexperienced surgeon during the management of traumatic injuries of the upper limb.

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“…Use of the unconscious sedative aided in the recovery of the patient from several of the operations. Furthermore, the transferred flap was thin, and provided just enough stability and vascularity for multiple re-expansions [13]. The re-expanded transferred flaps are also sufficient to cover defects from the removal of any newly developed or recurring nevi.…”

Section: Discussionmentioning

confidence: 99%

Giant congenital melanocytic nevus of the upper extremity: Coverage with a pre-expanded pedicled thoracodorsal artery perforator flap and re-expanded transferred flap

Yang

Kang

2020

Arch Aesthetic Plast Surg

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Giant congenital melanocytic nevi are rare, and it is recommended to excise due to the possibility of malignancy. Although tissue expansion for nevus removal involves multiple stages, the advantages of tissue expansion are known well. We report a case of a giant congenital melanocytic nevus of the upper extremity that extended from the elbow to the shoulder. This case was challenging due to the circumferential nature of the lesion, the lack of healthy skin, the need to ensure minimal scarring, and the desire to impact the patient's daily life as little as possible. The use of a pre-expanded thoracodorsal artery perforator (TDAP) flap and re-expansion of the transferred flap were considered most appropriate. A pre-expanded pedicled TDAP flap can be transferred to any anatomical region with its versatility. The re-expansion of the transferred flap ensures the health of the skin and minimizes donor site scarring. Here, we achieved the optimal outcome through the combined use of a pre-expanded pedicled TDAP flap and sequential re-expansion of the transferred flap in the treatment of a giant nevus of the upper extremity.

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Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity

Cited by 11 publications

References 40 publications

Reconstruction of post-traumatic upper extremity soft tissue defects with pedicled flaps: An algorithmic approach to clinical decision making

Reconstruction of post-traumatic upper extremity soft tissue defects with pedicled flaps: An algorithmic approach to clinical decision making

Upper limb traumatic injuries: A concise overview of reconstructive options

Giant congenital melanocytic nevus of the upper extremity: Coverage with a pre-expanded pedicled thoracodorsal artery perforator flap and re-expanded transferred flap

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