1,720,963 research outputs found
Flap coverage of dorsum of hand associated with extensor tendons injuries: A completely vascularized single-stage reconstruction
No full textThis study reports results in 12 patients treated with "completely vascularized single-stage approaches," so defined because skin, tendon, and nerve are transferred as a compound flap, and all are vascularized. A free dorsalis pedis cutaneotendinous flap was used in 7 patients, while a radial forearm cutaneotendinous island flap was transposed in 5 patients. A dorsalis pedis flap provides four vascularized extensor tendons (extensor digitorum comunis tendons), and the radial artery flap permits the inclusion of one completely vascularized tendon (palmaris longus) and two "strips" of vascularized tendons (flexor carpi radialis and brachioradialis). The flaps survived in all cases, and the transferred tendons were functioning well. The dorsalis pedis flap can be employed in the reconstruction of cutaneotendinous defects of the dorsum of the hand which require the use of three or four tendons grafts. We suggest the use of forearm cutaneotendinous flaps in cases of reconstruction of one or two extensor tendons. The "completely vascularized single-stage reconstruction" avoids prolonged hospitalization and results in a rapid restoration of near-normal function and appearance, of the hand. © 2003 Wiley-Liss, Inc
Nail lengthening and fingertip amputations
No full textFingertip injuries can be treated in different ways, including shortening with primary closure, skin grafts, and local or distant flaps. Nail bed involvement complicates fingertip reconstruction and may influence the choice of treatment. Local flaps can usually replace the pulp and provide a satisfactory functional and aesthetic result, whereas reconstruction of the fingernail apparatus is more difficult. In the period between 1998 and 2001, 12 fingertip injuries with nail bed involvement were treated with a combination of local flaps (Tranquilli-Leali and Venkataswami flaps) and the eponychial flap. The eponychial flap described by Bakhach is a backward cutaneous translation flap that lengthens the nail plate and restores a good appearance of the nail apparatus. This technique is simple to use and can be used with different flaps for pulp reconstruction
The aesthetic mini wrap-around technique for thumb reconstruction
No full textIn the past 12 years, 16 thumb defects at, or distal to, the interphalangeal joint were reconstructed using a great toe mini wrap-around flap. A flap including the entire nail and most of the distal phalanx of the great toe was used. Fifteen of the grafts survived. The sensory recovery of the reconstructed thumb was good as assessed by 2-point discrimination test with an average of 10 mm (range 5-15), and there were no complaints of cold intolerance. This technique results in good cosmetic appearance, and all patients were pleased with the cosmetic aspect of the thumb and there was no significant morbidity at the great toe donor site. The final decision to reconstruct a distal thumb amputation is influenced by gender, job, and age of the patients. The great toe mini wrap-around flap is an excellent reconstruction technique in selected patients
First Web-Space Reconstruction by the Anterolateral Thigh Flap
No full textFour patients with severe contracture of the first web space were treated with an anterolateral thigh perforator flap. The flap size ranged from 10 to 13 cm in length and from 7 to 8 cm in width. The donor site was closed directly and thinning of the flap was performed in all cases. All flaps survived and there were no re-explorations. Web space opening was maintained over the follow-up period. There was an average postoperative increase of the angle of the first web space of 61°. The thinned anterolateral thigh flap provides a pliable vascularized tissue for resurfacing the skin after release of severe contracture of the first web space and represents a reliable alternative to other flaps. © 2006 American Society for Surgery of the Hand
The reverse heterodigital neurovascular island flap for digital pulp reconstruction
No full textA heterodigital neurovascular reverse-flow flap island flap for extensive pulp defects is described. A dorsolateral flap from the middle phalanx, based on the digital artery, is harvested from the adjacent uninjured finger. The common digital artery between the injured finger and the donor finger is ligated and transected just before its bifurcation. At this point the 2 converging branches of the digital arteries can be entirely mobilized as a continuous vascular pedicle for the flap. The vascularization is now supplied by reverse flow through the proximal transverse digital palmar arch of the injured finger; to provide sensation, the dorsal branch of the digital nerve from the donor finger must be included in the flap. This technique is indicated for large pulp defects with bone exposure of index and middle finger pulps, which are important for sensation
Long-Term Results of Replantation for Complete Ring Avulsion Amputations
No full textRing avulsion injuries have long presented complex management problems. Despite microsurgical advances, it is difficult to achieve good functional results in complete degloving injuries or amputations, and their management remains somewhat controversial. Ten patients with class IV injuries according to Kay's classification were treated from 1986 to 2000. In this study the authors subdivided class IV injuries into those with amputation distal to the insertion of the flexor digitorum superficialis tendon (class IVd, 5 cases); those with amputation proximal to the insertion of the flexor digitorum superficialis tendon (class IVp, 3 cases); and complete degloving injuries leaving the tendons intact (class IVi, 2 cases). Replantation was done in class IVi and class IVd injuries, and 6 cases were revascularized successfully. In all these patients range of motion was complete at the metacarpal and proximal interphalangeal joints, but reestablishing sensibility was more difficult. Patients with class IVp injuries were treated by surgical amputation of the digit. Modifications of Kay's classification system based on anatomic injury is more predictive of functional outcome for completely amputated ring avulsion injuries. The authors conclude that complete ring avulsion amputations are salvageable, with acceptable functional results in select patients
Hand reconstruction using the thin anterolateral thigh flap
No full textPerforator flaps have been introduced for various kinds of reconstruction and resurfacing; in particular, the free thin anterolateral thigh flap is becoming one of the most preferred options for reconstruction of soft-tissue defects
Prefabbricazione su misura di un innesto osseo neovascolarizzato con camera cilindrica in idrossiapatite: studio sperimentale
No full textIl concetto di prefabbricazione dei tessuti è divenuto in questi ultimi anni una realtà della chirurgia ricostruttiva. In un lavoro precedentemente svolto si è valutata la possibilitàdi creare un innesto osseo neovascolarizzato; il nuovo studio rappresenta l’evoluzione del precedente. Lo scopo è stato quello di creare un innesto osseo prefabbricato neovascolarizzato avvalendosi però, in questo caso di biomateriali come l’idrossiapatite per definirne forma e dimensioni prestabilite. Lo studio è stato condotto su conigli New Zealand suddivisi in tre gruppi. Nel gruppo A (5 animali) si è eseguito un prelievo di tessuto spongioso dalla cresta iliaca poi inserito in una camera di idrossiapatite di 15 mm di diametro richiudibile con due dischi, uno dei quali con un foro di 8 mm di diametro per consentire il passaggio del peduncolo vascolare. La spongiosa è stata miscelata con microparticelle di forma sferica di idrossiapatite. Il tutto è stato “neovascolarizzato” con l’arteria e la vena femorale superficiale delconiglio. Nel gruppo B (5 animali) sono state utilizzate, a differenza del precedente, solamente le microparticelle di idrossiapatite all’interno della camera. Infine nel gruppo C, di controllo, (3 animali) si è impiegata l’associazione di spongiosa e microparticelle di idrossiapatite senza però ricorrere all’impianto del peduncolovascolare. Le camere di idrossiapatite, avvolte da un foglietto di silicone sono state posizionate in una “tasca” tra i muscoli della faccia mediale della coscia di ciascun animale. Gli animali sono stati sacrificati a distanza di 3 mesi dall’intervento chirurgicoe i frammenti ossei sono stati fissati in paraformaldeide e poi in poli-metil-metacrilato a 4°C. Sezioni spesse e sottili di segmenti ossei sono state utilizzate per lo studio su microradiografie ed istologico al microscopio ottico, a luce ordinaria, polarizzata e fluorescente. Sono stati inoltre eseguiti studi e valutazioni al microscopio elettronico a scansione. Nel primo gruppo l’analisi delle sezioni istologiche ha evidenziato la neoformazione di un tessuto fibroso avvolgente sia l’idrossiapatite che l’osso, la presenza di osteociti vivi e di numerosi vasi neoformati. Nel secondo gruppol’idrossiapatite è risultata avvolta da un tessuto connettivo con presenza di vasi neoformati nei pressi del peduncolo vascolare. Il terzo gruppo è stato caratterizzato da una completa assenza di tessuti neoformati. In conclusione l’involucro utilizzato permette di conferire all’impianto una forma prestabilita; i risultati dimostrano una volta di più la capacità dell’impianto vascolare di indurre la neovascolarizzazione e confermano le caratteristiche di osteoconduzione dell’idrossiapatite. Le camere di idrossiapatite si dimostrano un valido supporto nel tentativo di conferire all’impiantouna forma “su misura”
Reconstruction of large posttraumatic skeletal defects of the forearm by vascularized free fibular graft
No full textVascularized bone graft is most commonly applied for reconstruction of the lower extremity; indications for its use in the reconstruction of the upper extremity have expanded in recent years. Between 1993-2000, 12 patients with segmental bone defects following forearm trauma were managed with vascularized fibular grafts: 6 males and 6 females, aged 39 years on average (range, 16-65 years). The reconstructed site was the radius in 8 patients and the ulna in 4. The length of bone defect ranged from 6-13 cm. In 4 cases, the fibular graft was harvested and used as a vascularized fibula osteoseptocutaneous flap. To achieve fixation of the grafted fibula, plates were used in 10 cases, and screws and Kirschner wires in 2. In the latter 2 cases, an external skeletal fixator was applied to ensure immobilization of the extremity. The follow-up period ranged from 10-93 months. Eleven grafts were successful. The mean period to obtain radiographic bone union was 4.8 months (range, 2.5-8 months). Fibular grafts allow the use of a segment of diaphyseal bone which is structurally similar to the radius and ulna and of sufficient length to reconstruct most skeletal defects of the forearm. The vascularized fibular graft is indicated in patients with intractable nonunions where conventional bone grafting has failed or large bone defects, exceeding 6 cm, are observed in the radius or ulna. © 2004 Wiley-Liss, Inc
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