The Adipofascial Radial Artery Perforator Flap: A Versatile Reconstructive Option in Upper Limb Surgery

Samson, Deepak; Power, Dominic

doi:10.1142/s0218810415500227

Cited by 8 publications

(3 citation statements)

References 24 publications

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“…End neuroma following transection or neuroma in continuity following traction or compression may be treated with resection and epineurial repair of the parent nerve, burying the stump in muscle or bone, excision and repair with autograft, allograft or a conduit. [34][35][36] Barriers to scar can be achieved with local adipofascial flaps 37) or commercially available products. Collagen nerve wraps maintain nerve mobility following neurolysis.…”

Section: )mentioning

confidence: 99%

Iatrogenic Injuries of the Palmar Branch of the Median Nerve Following Volar Plate Fixation of the Distal Radius

Samson

Power

2017

J Hand Surg Asian-Pac Vol

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Background: Our aims were to identify iatrogenous injuries to the palmar branch of the median nerve sustained during volar plate fixation of the distal radius, make the clinician aware of this relatively uncommon complication of distal radius fixation, to emphasise common threads in symptomatology and to propose an algorithm for evaluation and management. Methods: Retrospectively interrogating our database over a 5 year period, the case records, neurophysiology records, operative records, therapy records were reviewed. The data was analysed with regard to the grade of surgeon performing the procedure, the site of injury, complexity of the fracture, delay to surgery, implant choice and outcome of the treatment. Variations in nerve anatomy were documented during revision surgery and common themes in symptomatology and clinical presentation were identified. Results: Seven patients with an iatrogenic injury involving the palmar branch of the median nerve associated with volar plate fixation of the distal radius were assessed. The male: female ratio was 1:6 and the mean age of patients was 47.8 years (33-74 years). The initial operative fixation was undertaken by a consultant orthopaedic surgeon at a mean of 7.8 (1-17) days from injury. The mean time from fracture fixation surgery to referral to the peripheral nerve injury service was 8.9 (2-36) months. Six patients presented with pain on attempted wrist extension. Five patients had parasthesia, hyperaesthesia or dysaesthesia in the distribution of the PCBMN. Anaesthesia or hypoaesthesia was present in three patients. Two patients presented with symptoms of complex regional pain syndrome (CRPS) Type 2. Conclusions: Revising relevant anatomy and possible variations as well as careful placements of retractors in the region of the median nerve could bring down these injuries. We propose an algorithm for their management.

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Section: )mentioning

confidence: 99%

Iatrogenic Injuries of the Palmar Branch of the Median Nerve Following Volar Plate Fixation of the Distal Radius

Samson

Power

2017

J Hand Surg Asian-Pac Vol

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“…In addition to the radial forearm flap, other flaps from the forearm can be used: ulnar artery flap or interoseus posterior flap (11,12). For mediumsized defects, flaps with radial or ulnar artery perforators may also be used (13,14).…”

Section: Introductionmentioning

confidence: 99%

Radial Flap in Reconstructions of the Hand - Case Series Study

Vulović

Kozarski

Curcic

et al. 2022

Serbian Journal of Experimental and Clinical Research

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Radial forearm flap is an axial flap that has become an important technique in reconstructive surgery as a free flap or as a pedicled flap. Defects of the skin and other tissues on the hand are very common and most often they are work-related injuries. In deep defects, flap must be used, as well as in reconstruction of the amputated thumb. There are many flaps that provide adequate soft tissue coverage for the hand. Therefore, the aim of this paper is to present the results of the use of radial forearm flap in various reconstructions on the hand. The retrospective study included 35 patients who underwent reconstruction with radial forearm flaps due to defects of the skin and other tissues on the hand, in the period 1997-2019. Results and complications of the surgery were analyzed. The functional and aesthetic outcome was assessed using Michigan Hand Outcome Qusteionnarire. All patients were followed for a minimum of 1 year. Fasciocutaneous flap was the most commonly used (65.71%), followed by adiposofascial (20%) and osteocutaneous (14.29%). The size of the fasciocutaneous flap ranged from 2.2x3.1cm to 9x13.5cm. The majority of donor sites were closed with split-thickness skin grafts (56.52%), and less frequently with direct suture, local skin flap, and full-thickness skin graft. There were no complete flap losses in the study. Marginal necrosis was noted in 8.57%, and graft failure at the donor site in 14.29%. Secondary surgical procedures were performed in 13 patients. The functional-aesthetic result of the operation, based on the MHQ score, ranged from 31 (1/35) to 130 points (3/35). The ultimate aim of hand reconstruction is to restore sufficient function and form, also, closing the wound within three days following the injury is desirable. Meticulous intraoperative dissection of radial flap and early physical therapy after surgery are mandatory. The radial flap is a suitable method, especially for large and more distal skin defects on the hand, and a very good method for thumb reconstruction.

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“…В случае глубоких дефектов эффективным является применение лоскутов с включением в их состав мышечных компонентов для заполнения «мертвых пространств» и профилактики гематом [22].…”

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Local, regional and distant flaps in reconstructive hand surgery in children

et al. 2022

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Objective. Hand injuries in children are quite common. Most challenging within plastic and reconstructive surgery/reconstructive microsurgery expertise were there traumatic hand defect and upper extremities open injuries sequels. There were wide variety of reconstruction techniques to deal with hand defects in general and with distal phalanx defects particularly. The core problem is how to make very choice of reconstructive method and technique from diversity of local, regional and distant flaps. Injuries of distal phalanges are the most common type of hand trauma in children. The problem of coverage of soft tissue defects of distal phalanges remains actual. A lot of methods of coverage of distal phalanges defects are developed. There is no generally accepted approach or an algorithm in the treatment of adults and children with such type of trauma.Material and methods. In the period from 2018 to 2021 at the Microsurgery Department of N.F. Filatov Moscow Clinical Hospital for Children 152 surgical operations using local (68), regional (72) and distant (12) flaps were performed.Results. All flaps in all patients within our clinical series have survived. There were neither major complication no secondary revisional procedures. Used different flaps in general provided transport of adequate viable donor tissues to recipient areas of critical functional significance. The selection of particular flap we have been making on individual basis mostly depending on type and injury severity, and functional requirement and prognosis.Conclusion. We are considering surgeon’s own experience is main defining factor to make selection of certain method from the diversity of different flaps.

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The Adipofascial Radial Artery Perforator Flap: A Versatile Reconstructive Option in Upper Limb Surgery

Abstract: We propose this flap as a viable, versatile reconstructive option for the hand and upper limb.

Cited by 8 publications

References 24 publications

Iatrogenic Injuries of the Palmar Branch of the Median Nerve Following Volar Plate Fixation of the Distal Radius

Iatrogenic Injuries of the Palmar Branch of the Median Nerve Following Volar Plate Fixation of the Distal Radius

Radial Flap in Reconstructions of the Hand - Case Series Study

Local, regional and distant flaps in reconstructive hand surgery in children

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