Purpose: This study conducted a comparative analysis of the effectiveness of split-thickness skin grafts (STSGs) and free flaps of the lateral thoracic region performed for coverage after extensive debridement in patients with difficult-to-treat chronic venous ulcers (CVUs) with severe symptoms.Methods: This retrospective, single-center study included 20 patients (28 cases) with CVUs. Patients who received an STSG or free-flap procedure were included in the study. Data comparing these two groups were analyzed.Results: The STSG and free-flap groups showed no significant differences in patient demographics. There was no significant difference in wound size before and after debridement between the two groups (before, 52.25±58.03 cm2 vs. 37.69±32.83 cm2, p=0.407; after, 210.92±202.80 cm2 vs. 142.63±84.01 cm2, p=0.291). Wound disruption was not significantly different between the groups (p=0.231). However, a significant difference was found in recurrence between the STSG group (n=7, 58.3%) and the free-flap group (n=1, 6.3%) (p=0.004).Conclusion: Free-flap surgery may be a good option for difficult-to-treat, recurrent CVU. Because venous ulcers require extensive debridement, a lateral thoracic region free flap, which enables the harvest of large and various forms of flaps, could be the best choice for microsurgery.
目的:本研究对症状严重的难治性慢性静脉溃疡(CVUs)患者广泛清创后，采用裂厚皮肤移植物(STSGs)和胸外侧区游离皮瓣进行覆盖的效果进行了比较分析。方法:回顾性、单中心研究纳入20例(28例)cvu患者。接受STSG或游离皮瓣手术的患者被纳入研究。分析两组比较资料。结果:STSG组和游离皮瓣组在患者人口统计学上无显著差异。两组患者清创前后创面大小差异无统计学意义(清创前:52.25±58.03 cm2 vs. 37.69±32.83 cm2, p=0.407;术后为210.92±202.80 cm2 vs. 142.63±84.01 cm2, p=0.291)。创面破裂组间差异无统计学意义(p=0.231)。然而，STSG组(n=7, 58.3%)与游离皮瓣组(n=1, 6.3%)的复发率差异有统计学意义(p=0.004)。结论:游离皮瓣手术可能是治疗难治性复发性CVU的良好选择。由于静脉溃疡需要广泛的清创，胸廓外侧游离皮瓣可以获得大的和各种形式的皮瓣，可能是显微手术的最佳选择。
{"title":"Surgical outcomes of split-thickness skin grafts versus free flaps of the lateral thoracic region for incurable chronic venous ulcers","authors":"Hyung Joon Seo, S. Park, Youn Hwan Kim","doi":"10.12790/ahm.22.0052","DOIUrl":"https://doi.org/10.12790/ahm.22.0052","url":null,"abstract":"Purpose: This study conducted a comparative analysis of the effectiveness of split-thickness skin grafts (STSGs) and free flaps of the lateral thoracic region performed for coverage after extensive debridement in patients with difficult-to-treat chronic venous ulcers (CVUs) with severe symptoms.Methods: This retrospective, single-center study included 20 patients (28 cases) with CVUs. Patients who received an STSG or free-flap procedure were included in the study. Data comparing these two groups were analyzed.Results: The STSG and free-flap groups showed no significant differences in patient demographics. There was no significant difference in wound size before and after debridement between the two groups (before, 52.25±58.03 cm2 vs. 37.69±32.83 cm2, p=0.407; after, 210.92±202.80 cm2 vs. 142.63±84.01 cm2, p=0.291). Wound disruption was not significantly different between the groups (p=0.231). However, a significant difference was found in recurrence between the STSG group (n=7, 58.3%) and the free-flap group (n=1, 6.3%) (p=0.004).Conclusion: Free-flap surgery may be a good option for difficult-to-treat, recurrent CVU. Because venous ulcers require extensive debridement, a lateral thoracic region free flap, which enables the harvest of large and various forms of flaps, could be the best choice for microsurgery.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121542835","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}
Patients with Apert syndrome require repeated limb surgery due to their complex deformities. In this study, a full-thickness isograft was performed for the division of Upton type III hands in identical twins with Apert syndrome. Nine-month-old identical twins presented with Apert syndrome characterized by craniosynostosis, severe syndactyly of the hands and feet, and dysmorphic facial features. Division and full-thickness skin grafting were performed. The siblings were operated consecutively on the same day. Following surgery for the younger sibling, there was an excess of graft left unused. In contrast, the older sibling required an additional skin graft of 1 × 1 cm. Full-thickness skin was successfully transferred between the twins without any rejection as of a 2-month follow-up. Thus, full-thickness skin isografting between monozygotic twins with Apert syndrome was successfully implemented.
{"title":"Isografting of full-thickness skin to treat syndactyly in monozygotic twins with Apert syndrome: a case report","authors":"Ji-Young Kim, Sunkyu Park, Byung Jun Kim","doi":"10.12790/ahm.22.0050","DOIUrl":"https://doi.org/10.12790/ahm.22.0050","url":null,"abstract":"Patients with Apert syndrome require repeated limb surgery due to their complex deformities. In this study, a full-thickness isograft was performed for the division of Upton type III hands in identical twins with Apert syndrome. Nine-month-old identical twins presented with Apert syndrome characterized by craniosynostosis, severe syndactyly of the hands and feet, and dysmorphic facial features. Division and full-thickness skin grafting were performed. The siblings were operated consecutively on the same day. Following surgery for the younger sibling, there was an excess of graft left unused. In contrast, the older sibling required an additional skin graft of 1 × 1 cm. Full-thickness skin was successfully transferred between the twins without any rejection as of a 2-month follow-up. Thus, full-thickness skin isografting between monozygotic twins with Apert syndrome was successfully implemented.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132065871","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}
Yang-Woo Kim, B. Moon, Sun Eung Kim, Hye Gwang Mun, W. Pae
Although several studies exist on the simple volume filling of soft tissue defects in lower extremity reconstruction, few reports have described functional reconstruction. In this study, a 52-year-old male patient, after a forklift accident, developed soft tissue defects of the all the right dorsiflexors. The patient underwent surgery with a chimeric anterolateral thigh free flap (cALT-FF), in which 18×8 cm2 fasciocutaneous flaps were harvested, including a 6×9 cm2 vastus lateralis muscle flap in a chimeric pattern. The functionality of the lower extremities was evaluated in terms of the active ankle-dorsiflexion range of motion and the Stanmore system after 15 months, and the result was good. In this study, we focused on functional reconstruction following the use of cALT-FF in a patient with defects of all the dorsiflexor muscles, which play an important functional role in gait.
{"title":"Functional reconstruction of total defects of the dorsiflexor muscles with a chimeric anterolateral thigh free flap: a case report","authors":"Yang-Woo Kim, B. Moon, Sun Eung Kim, Hye Gwang Mun, W. Pae","doi":"10.12790/ahm.22.0040","DOIUrl":"https://doi.org/10.12790/ahm.22.0040","url":null,"abstract":"Although several studies exist on the simple volume filling of soft tissue defects in lower extremity reconstruction, few reports have described functional reconstruction. In this study, a 52-year-old male patient, after a forklift accident, developed soft tissue defects of the all the right dorsiflexors. The patient underwent surgery with a chimeric anterolateral thigh free flap (cALT-FF), in which 18×8 cm2 fasciocutaneous flaps were harvested, including a 6×9 cm2 vastus lateralis muscle flap in a chimeric pattern. The functionality of the lower extremities was evaluated in terms of the active ankle-dorsiflexion range of motion and the Stanmore system after 15 months, and the result was good. In this study, we focused on functional reconstruction following the use of cALT-FF in a patient with defects of all the dorsiflexor muscles, which play an important functional role in gait.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"143 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115991994","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}
Penetrating injuries due to a plant thorn in the hand may occur during outdoor activities. We experienced two patients with rupture of the extensor digitorum communis (EDC) tendon in extensor zone V caused by plant thorn injuries. Both patients, presenting with pain and swelling around the third metacarpophalangeal joint, had a history of penetrating injuries due to plant thorns. The injuries had been ineffectively treated with oral antibiotics. Plain radiographs showed soft tissue swelling without a foreign body and bony lesions. Enhanced magnetic resonance imaging confirmed a rupture of the EDC tendon at the third extensor zone V. Tendon ruptures were diagnosed 27 and 60 days after injury, respectively. A plant thorn injury in the hand can cause persistent synovitis around the tendon, and as a result, progress to tendon rupture. A magnetic resonance imaging examination may be helpful if symptoms do not improve for a prolonged period after plant thorn injury.
{"title":"Rupture of the extensor digitorum communis tendon in extensor zone V due to plant thorn injuries: a report of two cases","authors":"M. Jang, Y. Heo, W. Shin","doi":"10.12790/ahm.22.0046","DOIUrl":"https://doi.org/10.12790/ahm.22.0046","url":null,"abstract":"Penetrating injuries due to a plant thorn in the hand may occur during outdoor activities. We experienced two patients with rupture of the extensor digitorum communis (EDC) tendon in extensor zone V caused by plant thorn injuries. Both patients, presenting with pain and swelling around the third metacarpophalangeal joint, had a history of penetrating injuries due to plant thorns. The injuries had been ineffectively treated with oral antibiotics. Plain radiographs showed soft tissue swelling without a foreign body and bony lesions. Enhanced magnetic resonance imaging confirmed a rupture of the EDC tendon at the third extensor zone V. Tendon ruptures were diagnosed 27 and 60 days after injury, respectively. A plant thorn injury in the hand can cause persistent synovitis around the tendon, and as a result, progress to tendon rupture. A magnetic resonance imaging examination may be helpful if symptoms do not improve for a prolonged period after plant thorn injury.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132475913","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}
Variations of the radial artery are rare, but clinically significant for surgeons when raising a radial forearm free flap. A 68-year-old man presented with an anomaly of the radial artery, which had a proximal bifurcation of the superficial palmar branch and an anomalous superficial course of the distal radial artery, mimicking duplication of the radial artery. A bifurcation of the main vessel was detected approximately 7 cm proximal to the wrist crease. Anastomosis was performed by using the superficial palmar branch of the radial artery. After anastomosis, the anomalously bifurcated deep palmar branch of the radial artery was transected 1 cm distal to the bifurcation. Although variations, such as unusual bifurcations of the radial artery, are extremely rare, surgeons should be aware of possible variations to ensure safe flap harvesting.
{"title":"Proximal bifurcation of the superficial palmar branch of the radial artery and anomalous superficial course of the distal radial artery","authors":"Young-Soo Choi, Hi-Jin You","doi":"10.12790/ahm.22.0047","DOIUrl":"https://doi.org/10.12790/ahm.22.0047","url":null,"abstract":"Variations of the radial artery are rare, but clinically significant for surgeons when raising a radial forearm free flap. A 68-year-old man presented with an anomaly of the radial artery, which had a proximal bifurcation of the superficial palmar branch and an anomalous superficial course of the distal radial artery, mimicking duplication of the radial artery. A bifurcation of the main vessel was detected approximately 7 cm proximal to the wrist crease. Anastomosis was performed by using the superficial palmar branch of the radial artery. After anastomosis, the anomalously bifurcated deep palmar branch of the radial artery was transected 1 cm distal to the bifurcation. Although variations, such as unusual bifurcations of the radial artery, are extremely rare, surgeons should be aware of possible variations to ensure safe flap harvesting.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120954865","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}
Schwannoma, or neurilemmoma, is a benign neoplasm that arises from Schwann cells, which surround peripheral, cranial, and autonomic nerve sheaths. Schwannoma has been reported to occur mainly as a singular lesion of the sacral nerve or sciatic nerve in young adults. Plexiform schwannoma, a subtype of schwannoma, is a rare neoplasm known to account for 2% to 5% of total schwannomas. Schwannoma of the upper extremities is relatively rare and is reported to occur mostly in the ulnar nerve. We report, with a literature review, a case of 4.2-cm and 2.8-cm symptomatic multiple plexiform schwannomas that occurred in the superficial radial nerve and were treated without neurologic sequelae by surgical resection.
{"title":"Surgical treatment of multiple plexiform schwannomas arising from the superficial radial nerve: a case report","authors":"T. Lee, Y. Lee, G. Ahn, J. Ahn","doi":"10.12790/ahm.22.0031","DOIUrl":"https://doi.org/10.12790/ahm.22.0031","url":null,"abstract":"Schwannoma, or neurilemmoma, is a benign neoplasm that arises from Schwann cells, which surround peripheral, cranial, and autonomic nerve sheaths. Schwannoma has been reported to occur mainly as a singular lesion of the sacral nerve or sciatic nerve in young adults. Plexiform schwannoma, a subtype of schwannoma, is a rare neoplasm known to account for 2% to 5% of total schwannomas. Schwannoma of the upper extremities is relatively rare and is reported to occur mostly in the ulnar nerve. We report, with a literature review, a case of 4.2-cm and 2.8-cm symptomatic multiple plexiform schwannomas that occurred in the superficial radial nerve and were treated without neurologic sequelae by surgical resection.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127367494","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}
Ahmad K. Almigdad, Mazen Odat, Ghandi Almanasir, Noor A. Megdadi, Sulieman Sharadgeh
Purpose: This study aimed to correlate the severity of carpal tunnel syndrome (CTS) in terms of the clinical picture with electrophysiological studies to determine whether the severity could be predicted through one measure based on correlations with another.Methods: This cross-sectional correlational study enrolled 96 patients (139 hands) whose nerve conduction studies (NCS) confirmed the diagnosis of CTS, and to whom the Boston Carpal Tunnel Questionnaire (BCTQ) was administered to determine the subjective and clinical CTS severity. The severity of both measures was correlated. Results: The patients’ mean age was 49.84±12.23 years. Most (67.7%) were female. The NCS severity grades were as follows: mild, 46%; moderate, 32.4; severe, 9.4%; and very severe, 12.2%. The sensory and motor NCS parameters were significantly correlated with the BCTQ severity. The patients’ overall mean scores for symptom severity had substantive predictive accuracy for the patients’ CTS severity measured with the NCS. Similarly, most of the functional severity score items had significant predictive accuracy for the patients’ NCS-based carpal tunnel severity score.Conclusion: The clinical severity of CTS was strongly correlated with the severity based on nerve conduction. This correlation was more notable for symptom severity scores than for functional status scores. Night pain and numbness demonstrated the strongest associations of all BCTQ items with the NCS. Although clinical severity (based on the BCTQ) predicts the nerve conduction severity, we still recommend performing NCS for patients with a clinical diagnosis of CTS as a confirmatory objective measure and for medico-legal reasons.
{"title":"Carpal tunnel syndrome: correlation of the severity of the clinical picture and electrophysiological studies","authors":"Ahmad K. Almigdad, Mazen Odat, Ghandi Almanasir, Noor A. Megdadi, Sulieman Sharadgeh","doi":"10.12790/ahm.22.0043","DOIUrl":"https://doi.org/10.12790/ahm.22.0043","url":null,"abstract":"Purpose: This study aimed to correlate the severity of carpal tunnel syndrome (CTS) in terms of the clinical picture with electrophysiological studies to determine whether the severity could be predicted through one measure based on correlations with another.Methods: This cross-sectional correlational study enrolled 96 patients (139 hands) whose nerve conduction studies (NCS) confirmed the diagnosis of CTS, and to whom the Boston Carpal Tunnel Questionnaire (BCTQ) was administered to determine the subjective and clinical CTS severity. The severity of both measures was correlated. Results: The patients’ mean age was 49.84±12.23 years. Most (67.7%) were female. The NCS severity grades were as follows: mild, 46%; moderate, 32.4; severe, 9.4%; and very severe, 12.2%. The sensory and motor NCS parameters were significantly correlated with the BCTQ severity. The patients’ overall mean scores for symptom severity had substantive predictive accuracy for the patients’ CTS severity measured with the NCS. Similarly, most of the functional severity score items had significant predictive accuracy for the patients’ NCS-based carpal tunnel severity score.Conclusion: The clinical severity of CTS was strongly correlated with the severity based on nerve conduction. This correlation was more notable for symptom severity scores than for functional status scores. Night pain and numbness demonstrated the strongest associations of all BCTQ items with the NCS. Although clinical severity (based on the BCTQ) predicts the nerve conduction severity, we still recommend performing NCS for patients with a clinical diagnosis of CTS as a confirmatory objective measure and for medico-legal reasons.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115100458","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, Jae Yong Lee, S. Koh, S. Roh, K. Lee, Jin Soo Kim
In traumatic amputations in the upper extremities, replantation has been commonly attempted with high success rates. However, successful replantation implies both the maintenance of length and good functional outcomes of the restored hand. Since the thumb accounts for 40% to 50% of hand function, the utmost priority is on the salvage of the thumb. In cases when replantation is not feasible, various efforts have been made to replace the thumb, including pollicization of the index finger, toe transfer, lengthening of the thumb stump, and deepening of the first web space. Alternatively, heterotopic thumb-to-thumb replantation has been suggested as a rescue plan in rare circumstances of bilateral amputation in the upper extremities. However, even if heterotopic replantation is successful, there are situations in which a severe crushing injury to the thenar muscles of the recipient’s thumb causes opposition failure of the reconstructed thumb. We report a case of functional reconstruction of the thumb in a rare case of bilateral mangling amputations in the upper extremities, by a heterotopic thumb-to-thumb replantation combined with secondary opponensplasty to compensate for the opposition failure.
{"title":"Functional reconstruction of the thumb by heterotopic thumb-to-thumb replantation and secondary opponensplasty in bilateral amputation in the upper extremities","authors":"Dong Chul Lee, Jae Yong Lee, S. Koh, S. Roh, K. Lee, Jin Soo Kim","doi":"10.12790/ahm.22.0042","DOIUrl":"https://doi.org/10.12790/ahm.22.0042","url":null,"abstract":"In traumatic amputations in the upper extremities, replantation has been commonly attempted with high success rates. However, successful replantation implies both the maintenance of length and good functional outcomes of the restored hand. Since the thumb accounts for 40% to 50% of hand function, the utmost priority is on the salvage of the thumb. In cases when replantation is not feasible, various efforts have been made to replace the thumb, including pollicization of the index finger, toe transfer, lengthening of the thumb stump, and deepening of the first web space. Alternatively, heterotopic thumb-to-thumb replantation has been suggested as a rescue plan in rare circumstances of bilateral amputation in the upper extremities. However, even if heterotopic replantation is successful, there are situations in which a severe crushing injury to the thenar muscles of the recipient’s thumb causes opposition failure of the reconstructed thumb. We report a case of functional reconstruction of the thumb in a rare case of bilateral mangling amputations in the upper extremities, by a heterotopic thumb-to-thumb replantation combined with secondary opponensplasty to compensate for the opposition failure.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131402172","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}
S. Roh, Jae Yong Lee, S. Koh, Jin Soo Kim, Dong Chul Lee, K. Lee
Purpose: Microsurgery in pediatric patients remains challenging because of technical difficulties in small-vessel anastomosis and flap dissection. Few reports have focused exclusively on the microsurgical reconstruction of traumatic hand defects in children. Herein, we share our experience of posttraumatic hand reconstruction with free tissue transfer in pediatric patients and compare the treatment outcomes with adults.Methods: A single-institution retrospective review of trauma-induced microsurgical hand reconstruction cases was performed. Pediatric patients below 17 years old and adults who underwent microsurgical reconstruction of traumatic hand defects between 2011 and 2021 were included. Patient demographics, flap type, use of vein grafts, operative time, flap survival, and postoperative complications were documented. A subgroup analysis of patients younger than 8 years was also performed. Data of pediatric patients were statistically compared with those of adults who underwent free flap surgery using nearly identical surgical procedures by four senior surgeons at our medical center.Results: Forty-one flaps in 39 pediatric patients and 184 flaps in 184 adult patients were analyzed. Fasciocutaneous flaps were predominantly used in both groups. In pediatric patients, all flaps survived, while 170 adults (92.4%) survived. No statistically significant between-group differences in treatment outcomes were found. However, pediatric patients (22.0%) had significantly fewer secondary operations than adults (67.4%, p<0.001).Conclusion: Microsurgical reconstruction for trauma-induced hand defects in pediatric patients has a high success rate and low complication rate, just as with adults. Pediatric patients may be more resistant to partial necrotic flap changes, thereby requiring fewer secondary operations than adults.
{"title":"Microsurgical reconstruction for traumatic hand defects in pediatric patients","authors":"S. Roh, Jae Yong Lee, S. Koh, Jin Soo Kim, Dong Chul Lee, K. Lee","doi":"10.12790/ahm.22.0021","DOIUrl":"https://doi.org/10.12790/ahm.22.0021","url":null,"abstract":"Purpose: Microsurgery in pediatric patients remains challenging because of technical difficulties in small-vessel anastomosis and flap dissection. Few reports have focused exclusively on the microsurgical reconstruction of traumatic hand defects in children. Herein, we share our experience of posttraumatic hand reconstruction with free tissue transfer in pediatric patients and compare the treatment outcomes with adults.Methods: A single-institution retrospective review of trauma-induced microsurgical hand reconstruction cases was performed. Pediatric patients below 17 years old and adults who underwent microsurgical reconstruction of traumatic hand defects between 2011 and 2021 were included. Patient demographics, flap type, use of vein grafts, operative time, flap survival, and postoperative complications were documented. A subgroup analysis of patients younger than 8 years was also performed. Data of pediatric patients were statistically compared with those of adults who underwent free flap surgery using nearly identical surgical procedures by four senior surgeons at our medical center.Results: Forty-one flaps in 39 pediatric patients and 184 flaps in 184 adult patients were analyzed. Fasciocutaneous flaps were predominantly used in both groups. In pediatric patients, all flaps survived, while 170 adults (92.4%) survived. No statistically significant between-group differences in treatment outcomes were found. However, pediatric patients (22.0%) had significantly fewer secondary operations than adults (67.4%, p<0.001).Conclusion: Microsurgical reconstruction for trauma-induced hand defects in pediatric patients has a high success rate and low complication rate, just as with adults. Pediatric patients may be more resistant to partial necrotic flap changes, thereby requiring fewer secondary operations than adults.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"158 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132191100","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}
End-to-end (ETE) and side-to-end (STE) anastomosis are two common configurations of lymphaticovenous anastomosis (LVA); however, it remains inconclusive which method is better. A 62-year-old man with lower extremity lymphedema underwent LVA with the STE method on the ankle. When the lymphatic vessel was cut for additional LVA at the proximal lower leg, blood drained out from the cut end of a lymphatic vessel, which suggested venous-lymphatic reflux at the STE anastomosis at the ankle. Because the reflux continued until 1 hour after the previous LVA at the ankle, the STE anastomosis at the ankle was re-explored and converted to ETE by ligation of the proximal lymphatic vessel. Reverse venous-lymphatic reflux was corrected, and a lymphovenous shunt was created immediately after the ligation. The current case suggests that STE anastomosis can be inferior to ETE anastomosis for creating a lymphovenous shunt when venous backflow exists.
{"title":"Persistent retrograde venous-lymphatic reflux in side-to-end lymphaticovenous anastomosis in a lower extremity with lymphedema: a case report","authors":"Kyong-Je Woo, Mi Kyung Lee, Jin-Woo Park","doi":"10.12790/ahm.22.0033","DOIUrl":"https://doi.org/10.12790/ahm.22.0033","url":null,"abstract":"End-to-end (ETE) and side-to-end (STE) anastomosis are two common configurations of lymphaticovenous anastomosis (LVA); however, it remains inconclusive which method is better. A 62-year-old man with lower extremity lymphedema underwent LVA with the STE method on the ankle. When the lymphatic vessel was cut for additional LVA at the proximal lower leg, blood drained out from the cut end of a lymphatic vessel, which suggested venous-lymphatic reflux at the STE anastomosis at the ankle. Because the reflux continued until 1 hour after the previous LVA at the ankle, the STE anastomosis at the ankle was re-explored and converted to ETE by ligation of the proximal lymphatic vessel. Reverse venous-lymphatic reflux was corrected, and a lymphovenous shunt was created immediately after the ligation. The current case suggests that STE anastomosis can be inferior to ETE anastomosis for creating a lymphovenous shunt when venous backflow exists.","PeriodicalId":137349,"journal":{"name":"Archives of Hand and Microsurgery","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128917455","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}
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