[Fasciocutaneous flap according to Becker and Gilbert].

Abstract

Objective: The fasciocutaneous flap according to Becker and Gilbert is used to cover soft tissue defects of the hand and wrist.

Indications: Soft tissue reconstruction of palmar and dorsal defects of the hand and wrist. Coverage of the median nerve after neurolysis.

Contraindications: Stenosis of the ulnar artery, scars at the ulnar distal forearm.

Surgical technique: Drawing the flap design with the pivot point 2-4 cm proximal to the pisiform. Maximal length: 20 cm, maximal width: between palmaris longus muscle and finger extensor tendons. The flap is cut from radial palmar to ulnar dorsal and from proximal to distal together with the underlying fascia. The ulnar artery, the ulnar nerve and the dorsal branch of the ulnar artery are prepared distally. After cutting the distal skin bridge the flap is transposed to the defect. The donor side is closed directly or by a skin graft. As a modification, the flap is prepared as a fascious flap with overlying fat to cover the median nerve after neurolysis.

Postoperative management: Immobilization of the wrist , in a soft palmar cast for 10 days; regular examination of the circulation of a fasciocutaneous flap.

Results: The Becker flap was used in 10 persons: 4 times as fasciocutaneous flap, 6 times as fascious flap. For closing the donor side, a skin graft was necessary in 2 cases; no flap was lost.