Kuylhee Kim, Donghyun Lee, Soyeon Jung, Chul Hoon Chung, Y. Chang
This case report presents two female-to-male (FTM) patients, aged 21 and 35 years, respectively, who underwent phalloplasty and urethral reconstruction at our institution. The patients’ requests included a phallus >9 cm, concealed donor-site scars, and the ability to void while standing. In the first case, a 4.5×13-cm radial forearm free flap (RFFF) taken from the nondominant side was retrieved and anastomosed to the deep inferior epigastric artery and vein. Simultaneously, a 10×16-cm pedicled anterolateral thigh (ALT) flap was relocated to the genital area and wrapped around the RFFF after nerve coaptation. The second case involved a 5.5×14-cm RFFF and a 20×13-cm pedicled ALT flap using a similar procedure. Both cases had stable double flaps with no complications, and Foley catheters were removed at 14 days and 3 months after surgery, respectively. Double-flap phalloplasty is thus a viable option for patients with a short forearm circumference or a preference for a less visible forearm scar.
{"title":"Pedicled anterolateral thigh flap phalloplasty combined with radial forearm free flap urethral reconstruction in gender-affirming surgery: a report of two cases","authors":"Kuylhee Kim, Donghyun Lee, Soyeon Jung, Chul Hoon Chung, Y. Chang","doi":"10.12790/ahm.23.0041","DOIUrl":"https://doi.org/10.12790/ahm.23.0041","url":null,"abstract":"This case report presents two female-to-male (FTM) patients, aged 21 and 35 years, respectively, who underwent phalloplasty and urethral reconstruction at our institution. The patients’ requests included a phallus >9 cm, concealed donor-site scars, and the ability to void while standing. In the first case, a 4.5×13-cm radial forearm free flap (RFFF) taken from the nondominant side was retrieved and anastomosed to the deep inferior epigastric artery and vein. Simultaneously, a 10×16-cm pedicled anterolateral thigh (ALT) flap was relocated to the genital area and wrapped around the RFFF after nerve coaptation. The second case involved a 5.5×14-cm RFFF and a 20×13-cm pedicled ALT flap using a similar procedure. Both cases had stable double flaps with no complications, and Foley catheters were removed at 14 days and 3 months after surgery, respectively. Double-flap phalloplasty is thus a viable option for patients with a short forearm circumference or a preference for a less visible forearm scar.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139225987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The indications for total elbow arthroplasty have been expanded beyond severe arthritis to include acute comminuted fractures. Advances in implant manufacturing and surgical techniques in recent decades have led to increasingly better results. Semiconstrained implants are most commonly used, followed by conversion-type and unlinked implants. However, the results are still worse than those of arthroplasty in the knee or hip joint, and various complications such as aseptic loosening, infection, bushing wear, and periprosthetic fractures still occur. As aging adults are increasingly indicated for surgery, we inevitably face complications that are not easy to control. In this review, we discuss intraoperative and late complications, their prevention, and treatment options.
{"title":"Complications of total elbow arthroplasty","authors":"S. Cha, I. Ga, Yong Hwan Kim, H. Shin","doi":"10.12790/ahm.23.0024","DOIUrl":"https://doi.org/10.12790/ahm.23.0024","url":null,"abstract":"The indications for total elbow arthroplasty have been expanded beyond severe arthritis to include acute comminuted fractures. Advances in implant manufacturing and surgical techniques in recent decades have led to increasingly better results. Semiconstrained implants are most commonly used, followed by conversion-type and unlinked implants. However, the results are still worse than those of arthroplasty in the knee or hip joint, and various complications such as aseptic loosening, infection, bushing wear, and periprosthetic fractures still occur. As aging adults are increasingly indicated for surgery, we inevitably face complications that are not easy to control. In this review, we discuss intraoperative and late complications, their prevention, and treatment options.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139231310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: The aim of this study was to determine whether normal plating yields comparable outcomes to plating using additional bioabsorbable screws or wires for complex distal radial fractures.Methods: Among 80 patients with complex distal radius fractures treated between January 2018 and March 2021, 45 were studied retrospectively and divided into two groups as follows: group A (n=23) received a plate, and group B (n=22) received a plate with a bioresorbable screw or wire. Radiological studies evaluated the period of bone union, radial length, inclination, and resorption of the bioresorbable screws or wires after surgery. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was examined for clinical evaluation, and complications were compared between the two groups.Results: The two groups showed similar distributions in sex, age, injury mechanism, diabetes mellitus, smoking, and mean follow-up period; however, there were no statistically significant differences in the period of bone union and maintenance of reduction (radial length, inclination, and volar tilt). The DASH score averaged 14.8 and 13.2 points in groups A and B, respectively, showing no significant difference in complications (nonunion, malunion, infection, and arthritis).Conclusion: Regardless of the use of additional bioresorbable screws or wires, reduction in distal radius fractures in both groups yielded good results. Plating with additional bioresorbable screws or wires may be a suitable fixation method to compensate for the shortcomings of metal implants in complex distal radius fractures.
{"title":"The usefulness of bioabsorbable magnesium implants in addition to metal plates in the treatment of complex distal radius fractures","authors":"Tae-Gyu Park, K. An, Young Jae Kim","doi":"10.12790/ahm.23.0037","DOIUrl":"https://doi.org/10.12790/ahm.23.0037","url":null,"abstract":"Purpose: The aim of this study was to determine whether normal plating yields comparable outcomes to plating using additional bioabsorbable screws or wires for complex distal radial fractures.Methods: Among 80 patients with complex distal radius fractures treated between January 2018 and March 2021, 45 were studied retrospectively and divided into two groups as follows: group A (n=23) received a plate, and group B (n=22) received a plate with a bioresorbable screw or wire. Radiological studies evaluated the period of bone union, radial length, inclination, and resorption of the bioresorbable screws or wires after surgery. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was examined for clinical evaluation, and complications were compared between the two groups.Results: The two groups showed similar distributions in sex, age, injury mechanism, diabetes mellitus, smoking, and mean follow-up period; however, there were no statistically significant differences in the period of bone union and maintenance of reduction (radial length, inclination, and volar tilt). The DASH score averaged 14.8 and 13.2 points in groups A and B, respectively, showing no significant difference in complications (nonunion, malunion, infection, and arthritis).Conclusion: Regardless of the use of additional bioresorbable screws or wires, reduction in distal radius fractures in both groups yielded good results. Plating with additional bioresorbable screws or wires may be a suitable fixation method to compensate for the shortcomings of metal implants in complex distal radius fractures.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"10 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139258117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Locked metacarpophalangeal joint (MCPJ) is mainly caused by joint pathologies, although tendinopathy is also a possible cause. Furthermore, it can be misdiagnosed as tendinopathy with triggering symptoms. Herein, we present a 60-year-old housewife with thumb flexion inability lasting for 4 months. Three weeks previously, she visited another clinic and was misdiagnosed with trigger thumb. Her symptoms did not resolve after trigger thumb surgery. At our clinic, physical examination and imaging studies were conducted. Sesamoid arthritic change with entrapment in the MCPJ was found, and the entrapped sesamoid bone inhibited flexion of the MCPJ of the thumb. Based on the examinations, radial sesamoidectomy was planned. After surgery, the patient recovered a passive full range of motion immediately. Despite a rehabilitation program, at 6 months postoperatively, severe stiffness and contracture at the MCPJ were noted. Therefore, a second operation with tenolysis and volar plate release was conducted under wide-awake anesthesia. Intraoperatively, severe adhesion was observed in flexor tendon, volar plate release was performed, and small defects were found in the volar plate when thumb was fully extended. To prevent secondary healing of the volar plate defect, a dorsoradial adipofascial flap was used. At 6 months after the second surgery, the patient’s range of motion in the MCPJ had improved, and she resumed activities of daily living without other complications. Hand surgeons frequently misdiagnose conditions as trigger finger if there is triggering or locked-joint symptoms. An accurate preoperative diagnosis with a detailed physical examination and imaging studies are essential for better operative results.
{"title":"Sesamoid arthritis with locked metacarpophalangeal joint misdiagnosed as trigger finger: a case report","authors":"Sang Ho Oh, J. Kang","doi":"10.12790/ahm.23.0032","DOIUrl":"https://doi.org/10.12790/ahm.23.0032","url":null,"abstract":"Locked metacarpophalangeal joint (MCPJ) is mainly caused by joint pathologies, although tendinopathy is also a possible cause. Furthermore, it can be misdiagnosed as tendinopathy with triggering symptoms. Herein, we present a 60-year-old housewife with thumb flexion inability lasting for 4 months. Three weeks previously, she visited another clinic and was misdiagnosed with trigger thumb. Her symptoms did not resolve after trigger thumb surgery. At our clinic, physical examination and imaging studies were conducted. Sesamoid arthritic change with entrapment in the MCPJ was found, and the entrapped sesamoid bone inhibited flexion of the MCPJ of the thumb. Based on the examinations, radial sesamoidectomy was planned. After surgery, the patient recovered a passive full range of motion immediately. Despite a rehabilitation program, at 6 months postoperatively, severe stiffness and contracture at the MCPJ were noted. Therefore, a second operation with tenolysis and volar plate release was conducted under wide-awake anesthesia. Intraoperatively, severe adhesion was observed in flexor tendon, volar plate release was performed, and small defects were found in the volar plate when thumb was fully extended. To prevent secondary healing of the volar plate defect, a dorsoradial adipofascial flap was used. At 6 months after the second surgery, the patient’s range of motion in the MCPJ had improved, and she resumed activities of daily living without other complications. Hand surgeons frequently misdiagnose conditions as trigger finger if there is triggering or locked-joint symptoms. An accurate preoperative diagnosis with a detailed physical examination and imaging studies are essential for better operative results.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"295 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139256741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dong Chul Lee, Chang Park, Jin Soo Kim, S. Koh, S. Roh, K. Lee
Purpose: Bacterial infection is a critical complication influencing the survival of a replanted digit. This study aimed to identify risk factors for bacterial infection following zone 1 replantation.Methods: A retrospective chart review was conducted on patients who underwent zone 1 replantation from January 2016 to November 2022. The factors included in the comparative analysis were patient demographics (age, sex), past medical history (hypertension, diabetes mellitus), smoking, types of injury, degree of contamination, source of trauma, fractures, number of vascular anastomoses, use of salvage therapies, and the use of vein grafts. A bacterial infection was diagnosed based on observation of visible inflammatory signs with the results of culture studies.Results: In total, 313 patients were selected. Thirty-eight cases of bacterial infection were identified, which accounted for 12.1% of total patients. Methicillin-resistant Staphylococcus epidermidis (MRSE) was the most prevalent bacterium (63.2%, 24 of 38 cases). The patient and injury-related factors showed no significant differences, but the number of vein anastomoses and use of salvage therapy were significantly correlated with the occurrence of bacterial infection.Conclusion: Performing fewer vein anastomoses appears to increase the likelihood of a salvage procedure, and subsequently increases the risk of bacterial infection by an increased need for direct wound manipulation after zone 1 replantation. Infections caused by MRSE were more commonly identified than those by Aeromonas hydrophilia, which is a commonly known pathogen in medicinal leeches.
{"title":"Risk factors for bacterial infection following replantation of zone 1 amputation","authors":"Dong Chul Lee, Chang Park, Jin Soo Kim, S. Koh, S. Roh, K. Lee","doi":"10.12790/ahm.23.0023","DOIUrl":"https://doi.org/10.12790/ahm.23.0023","url":null,"abstract":"Purpose: Bacterial infection is a critical complication influencing the survival of a replanted digit. This study aimed to identify risk factors for bacterial infection following zone 1 replantation.Methods: A retrospective chart review was conducted on patients who underwent zone 1 replantation from January 2016 to November 2022. The factors included in the comparative analysis were patient demographics (age, sex), past medical history (hypertension, diabetes mellitus), smoking, types of injury, degree of contamination, source of trauma, fractures, number of vascular anastomoses, use of salvage therapies, and the use of vein grafts. A bacterial infection was diagnosed based on observation of visible inflammatory signs with the results of culture studies.Results: In total, 313 patients were selected. Thirty-eight cases of bacterial infection were identified, which accounted for 12.1% of total patients. Methicillin-resistant Staphylococcus epidermidis (MRSE) was the most prevalent bacterium (63.2%, 24 of 38 cases). The patient and injury-related factors showed no significant differences, but the number of vein anastomoses and use of salvage therapy were significantly correlated with the occurrence of bacterial infection.Conclusion: Performing fewer vein anastomoses appears to increase the likelihood of a salvage procedure, and subsequently increases the risk of bacterial infection by an increased need for direct wound manipulation after zone 1 replantation. Infections caused by MRSE were more commonly identified than those by Aeromonas hydrophilia, which is a commonly known pathogen in medicinal leeches.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116839859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Multiple metacarpal shaft fractures are higher-energy injuries than single metacarpal shaft injuries and are considered relatively unstable because reduction is easily lost after splinting. However, few studies have been published on operative treatment because these fractures are rare. The aim of this study was to analyze the characteristics of this rare type of fracture and report the surgical outcomes.Methods: Medical records of patients with adjacent metacarpal shaft fractures who underwent surgery were retrospectively analyzed. In total, 20 cases were included in this study. A single longitudinal incision was made at the middle of the web space of affected metacarpal bones. Fractures were fixed using a plate and screws. The clinical results were evaluated by determining the metacarpophalangeal joint range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and hand grip strength at the final follow-up. Results: Among the patients included, there were 15 male and five female patients. Their mean age was 41.2 years. The average range of motion of metacarpophalangeal joints was 78.1°. The average DASH score was 6.5. The average hand grip strength was 92.4% compared to the unaffected side. The mean time to union was 7.5 weeks. There were no cases of complications, such as soft tissue infections, joint stiffness, or extensor tendon injuries.Conclusion: Plate fixation through a single incisional approach performed for adjacent metacarpal shaft fractures showed satisfactory results. This could be a recommendable approach for two unstable adjoining metacarpal shaft fractures.
{"title":"Plate fixation with a single incisional approach in adjoining two metacarpal shaft fractures","authors":"C. Oh, Cheungsoo Ha, Jeeseop Shin, Soo-Hong Han","doi":"10.12790/ahm.23.0021","DOIUrl":"https://doi.org/10.12790/ahm.23.0021","url":null,"abstract":"Purpose: Multiple metacarpal shaft fractures are higher-energy injuries than single metacarpal shaft injuries and are considered relatively unstable because reduction is easily lost after splinting. However, few studies have been published on operative treatment because these fractures are rare. The aim of this study was to analyze the characteristics of this rare type of fracture and report the surgical outcomes.Methods: Medical records of patients with adjacent metacarpal shaft fractures who underwent surgery were retrospectively analyzed. In total, 20 cases were included in this study. A single longitudinal incision was made at the middle of the web space of affected metacarpal bones. Fractures were fixed using a plate and screws. The clinical results were evaluated by determining the metacarpophalangeal joint range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and hand grip strength at the final follow-up. Results: Among the patients included, there were 15 male and five female patients. Their mean age was 41.2 years. The average range of motion of metacarpophalangeal joints was 78.1°. The average DASH score was 6.5. The average hand grip strength was 92.4% compared to the unaffected side. The mean time to union was 7.5 weeks. There were no cases of complications, such as soft tissue infections, joint stiffness, or extensor tendon injuries.Conclusion: Plate fixation through a single incisional approach performed for adjacent metacarpal shaft fractures showed satisfactory results. This could be a recommendable approach for two unstable adjoining metacarpal shaft fractures.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134023618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Soft tissue defects can occur in the head and neck due to various causes, and head and neck surgery is often performed to reconstruct soft tissue defects. However, head and neck reconstruction remains delicate and complex as a surgical procedure. The reconstruction of a large defect at the base of the skull, especially after resection of cancer in the anterior base of the skull that has invaded adjacent tissues, is particularly difficult. We present a case of successful reconstruction of a large skull base defect using an anterolateral thigh (ALT) free flap and galeal flap division after tumor resection in the anterior skull base. Paranasal sinus cancer involving the bilateral frontoethmoidal sinuses was resected, and an anterior skull base defect was noted, with communication between the intracranium and nasal cavity and a skin defect at the glabella. A galeal flap was divided to create an anatomical and functional barrier to communication between the nasal cavity and intracranium. The soft tissue defect at the anterior skull base was then reconstructed using an ALT free flap containing the vastus lateralis muscle, and the skin defect at the glabella was covered. No postoperative complications, such as cerebrospinal fluid leakage, developed. The reconstructed flap remained intact after subsequent radiation therapy. Based on this study, we propose that using a galeal flap and ALT free flap in a large skull base defect can yield a robust flap that can endure postoperative radiotherapy with a minimal risk of complications.
{"title":"Reconstruction of a skull base defect with cutaneous nasocranial communication using a combination of an anterolateral thigh free flap and galeal flap division: a case report","authors":"Yo Han Kim, J. Hong","doi":"10.12790/ahm.23.0019","DOIUrl":"https://doi.org/10.12790/ahm.23.0019","url":null,"abstract":"Soft tissue defects can occur in the head and neck due to various causes, and head and neck surgery is often performed to reconstruct soft tissue defects. However, head and neck reconstruction remains delicate and complex as a surgical procedure. The reconstruction of a large defect at the base of the skull, especially after resection of cancer in the anterior base of the skull that has invaded adjacent tissues, is particularly difficult. We present a case of successful reconstruction of a large skull base defect using an anterolateral thigh (ALT) free flap and galeal flap division after tumor resection in the anterior skull base. Paranasal sinus cancer involving the bilateral frontoethmoidal sinuses was resected, and an anterior skull base defect was noted, with communication between the intracranium and nasal cavity and a skin defect at the glabella. A galeal flap was divided to create an anatomical and functional barrier to communication between the nasal cavity and intracranium. The soft tissue defect at the anterior skull base was then reconstructed using an ALT free flap containing the vastus lateralis muscle, and the skin defect at the glabella was covered. No postoperative complications, such as cerebrospinal fluid leakage, developed. The reconstructed flap remained intact after subsequent radiation therapy. Based on this study, we propose that using a galeal flap and ALT free flap in a large skull base defect can yield a robust flap that can endure postoperative radiotherapy with a minimal risk of complications.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128296400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jae-Woo Heo, Yong Joo Chi, Hyun Sik Park, J. Whang
Purpose: Although various surgical reconstruction methods are available for multidigit defects or soft tissue defects of the hand, they often require a thin flap due to the hand’s unique physical characteristics. We performed a total of 13 cases of lateral arm free flap surgery at our hospital. The purpose of this study was to report the usefulness of this technique.Methods: This study included the following cases: four cases of multiple digit amputations, seven cases of hand dorsum skin defects, one case of first web reconstruction due to web contracture, and one case of an index finger bone and soft tissue defect with only the ulnar-side neuro-vascular bundle remaining. After emergency simple debridement, subsequent reconstruction was performed using a lateral arm free flap.Results: All 13 cases healed without necrosis. Patients who underwent finger amputation were able to preserve the length of their fingers without any additional amputation. Patients who initially had hand dorsum defects were able to maintain grasping function after flap stabilization. The patient with web contracture was able to recover the lost pinching function, and the patient with a combined loss of osteoarticular and soft tissue of the index finger maintained the shape and length of the finger despite the absence of joint function.Conclusion: The lateral arm free flap is a useful reconstruction method that can be easily performed with a single session of regional anesthesia. Since the flap is thin, it is suitable for hand defect reconstruction. If necessary, vascularized bone grafting is possible.
{"title":"Usefulness of the lateral arm free flap for hand defect reconstruction","authors":"Jae-Woo Heo, Yong Joo Chi, Hyun Sik Park, J. Whang","doi":"10.12790/ahm.23.0011","DOIUrl":"https://doi.org/10.12790/ahm.23.0011","url":null,"abstract":"Purpose: Although various surgical reconstruction methods are available for multidigit defects or soft tissue defects of the hand, they often require a thin flap due to the hand’s unique physical characteristics. We performed a total of 13 cases of lateral arm free flap surgery at our hospital. The purpose of this study was to report the usefulness of this technique.Methods: This study included the following cases: four cases of multiple digit amputations, seven cases of hand dorsum skin defects, one case of first web reconstruction due to web contracture, and one case of an index finger bone and soft tissue defect with only the ulnar-side neuro-vascular bundle remaining. After emergency simple debridement, subsequent reconstruction was performed using a lateral arm free flap.Results: All 13 cases healed without necrosis. Patients who underwent finger amputation were able to preserve the length of their fingers without any additional amputation. Patients who initially had hand dorsum defects were able to maintain grasping function after flap stabilization. The patient with web contracture was able to recover the lost pinching function, and the patient with a combined loss of osteoarticular and soft tissue of the index finger maintained the shape and length of the finger despite the absence of joint function.Conclusion: The lateral arm free flap is a useful reconstruction method that can be easily performed with a single session of regional anesthesia. Since the flap is thin, it is suitable for hand defect reconstruction. If necessary, vascularized bone grafting is possible.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132117422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
An 83-year-old male patient presented with a Marjolin’s ulcer on his lower leg, which developed 60 years after a bomb blast injury. The lesion was a 24×12-cm2 chronic ulcer located circumferentially around the mid-third lower leg. Considering the patient’s age, vessel status, and the extent of the defect after wide excision, which included a section of the tibia, reconstruction utilizing bilateral anterolateral thigh free flaps in a flow-through pattern under spinal-epidural anesthesia was planned. The operative time was 9 hours, and the patient fully recovered without any complications. The patient was able to walk without any orthosis, and no evidence of recurrence was found during a 3-year postoperative follow-up period.
{"title":"Bilateral anterolateral thigh free flap in a flow-through chimeric pattern for a extensively large defect reconstruction: a case of an elderly patient under spinal-epidural anesthesia","authors":"H. Cha, Dong Gyu Kim, S. Nam, C. Choi","doi":"10.12790/ahm.23.0022","DOIUrl":"https://doi.org/10.12790/ahm.23.0022","url":null,"abstract":"An 83-year-old male patient presented with a Marjolin’s ulcer on his lower leg, which developed 60 years after a bomb blast injury. The lesion was a 24×12-cm2 chronic ulcer located circumferentially around the mid-third lower leg. Considering the patient’s age, vessel status, and the extent of the defect after wide excision, which included a section of the tibia, reconstruction utilizing bilateral anterolateral thigh free flaps in a flow-through pattern under spinal-epidural anesthesia was planned. The operative time was 9 hours, and the patient fully recovered without any complications. The patient was able to walk without any orthosis, and no evidence of recurrence was found during a 3-year postoperative follow-up period.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115528337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jae-Woo Heo, J. Whang, Hyun Sik Park, Yong Joo Chi, Deok Hyeon Yu, Junsang Lee, Jung-Kwon Cha, Bum-Suk Oh
Purpose: The radial artery superficial palmar branch (RASP) free flap is accepted as a surgical technique for the reconstruction of finger defects. This study revisited the RASP free flap and evaluated its reliability and usefulness in a variety of finger defects.Methods: From January 2017 to December 2022, multiple surgeons at a single institution performed a total of 315 RASP free flap reconstructions. Basic patient demographics and information on the finger defect and flap were assessed, and immediate postoperative flap and donor site-related complications were also studied. Data regarding long-term outcomes, such as the thumb joint range of motion and static two-point discrimination (S2PD), were collected and evaluated to identify statistically significant differences from the unaffected or non-innervated side. Results: The mean postoperative follow-up was 14.8 months. The total flap survival rate was approximately 91.4%. There was no statistically significant difference in mean postoperative palmar abduction and radial abduction between the affected and unaffected thumbs in both groups. In the single-digit group, there was a statistically significant difference in S2PD between the innervated flap and unaffected side. A statistically significant difference was also found between innervated and non-innervated flaps in the multiple-digits group. Conclusion: The RASP free flap is a valuable surgical option in reconstructing finger defects. It has already been proven to be safe and useful in coverage of single and tip defects. Stability should be ensured when there are multiple defects. Finally, the donor site morbidity is minimal and the recovery of sensation, once the flap is reinnervated, could be promising.
{"title":"Finger defect reconstruction using the radial artery superficial palmar branch free flap","authors":"Jae-Woo Heo, J. Whang, Hyun Sik Park, Yong Joo Chi, Deok Hyeon Yu, Junsang Lee, Jung-Kwon Cha, Bum-Suk Oh","doi":"10.12790/ahm.23.0017","DOIUrl":"https://doi.org/10.12790/ahm.23.0017","url":null,"abstract":"Purpose: The radial artery superficial palmar branch (RASP) free flap is accepted as a surgical technique for the reconstruction of finger defects. This study revisited the RASP free flap and evaluated its reliability and usefulness in a variety of finger defects.Methods: From January 2017 to December 2022, multiple surgeons at a single institution performed a total of 315 RASP free flap reconstructions. Basic patient demographics and information on the finger defect and flap were assessed, and immediate postoperative flap and donor site-related complications were also studied. Data regarding long-term outcomes, such as the thumb joint range of motion and static two-point discrimination (S2PD), were collected and evaluated to identify statistically significant differences from the unaffected or non-innervated side. Results: The mean postoperative follow-up was 14.8 months. The total flap survival rate was approximately 91.4%. There was no statistically significant difference in mean postoperative palmar abduction and radial abduction between the affected and unaffected thumbs in both groups. In the single-digit group, there was a statistically significant difference in S2PD between the innervated flap and unaffected side. A statistically significant difference was also found between innervated and non-innervated flaps in the multiple-digits group. Conclusion: The RASP free flap is a valuable surgical option in reconstructing finger defects. It has already been proven to be safe and useful in coverage of single and tip defects. Stability should be ensured when there are multiple defects. Finally, the donor site morbidity is minimal and the recovery of sensation, once the flap is reinnervated, could be promising.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115233260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：