The use of pedicled abdominal flaps for coverage of acute bilateral circumferential degloving injuries of the hand

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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“…12), dorsal (Fig. 13), circumferential wounds 23, 24. The hypogastric flap is an excellent option to cover dorsum of hand & fingers (Fig.…”

Section: Methodsmentioning

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 vascularization of the injured limb is not potentially compromised because there is not vessels manipulation in comparison with free flap. Moreover, they can be thinned during the second surgical step almost up to the subdermal level [ 21 , 22 ]. The training period, the attention to details and the ability to perform are certainly lower than the microsurgical ones and give the surgeon a greater level of confidence when facing with a complex defect [ 20 ].…”

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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“…An associated thumb defect is a challenge as the thumb has to be oriented in a different plane from the rest of the hand, thus usually warranting an additional flap. 6…”

Section: Discussionmentioning

confidence: 99%

The “Standing Cone” Flap for Thumb: A Spinoff the Hypogastric Flap in Combined Defects of Dorsum of Hand and Thumb

Garg

Sharma

John

2019

Hand (New York, N,Y.)

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Background: The management of combined defects of the dorsum of the hand and the thumb can be quite challenging. The conventional teaching has been to use more than 1 flap for such discontinuous defects of the hand. Methods: We present a novel technique to provide a reliable skin cover to a concomitant second defect over thumb, which otherwise would require an additional flap, by recruiting the excess skin available after closure of the primary flap donor site of the hypogastric flap being used for the defect on the dorsum of hand. We report a case series of 5 patients wherein this technique has been used successfully. Results: The modified technique was able to successfully manage the concomitant defects of the dorsum of hand and the thumb in 1 stage. Conclusions: We find this innovation can help cover 2 separate defects on dorsum of hand and the thumb in 1 stage by utilizing just 1 flap instead of the conventional method of raising 2 flaps for such defects

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The use of pedicled abdominal flaps for coverage of acute bilateral circumferential degloving injuries of the hand

Cited by 20 publications

References 24 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

The “Standing Cone” Flap for Thumb: A Spinoff the Hypogastric Flap in Combined Defects of Dorsum of Hand and Thumb

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