Reliability of propeller flaps in post-traumatic reconstruction of wrist and hand defects
- PDF / 972,148 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 80 Downloads / 176 Views
ORIGINAL ARTICLE
Reliability of propeller flaps in post‑traumatic reconstruction of wrist and hand defects Hassan Abdel Hamid Abdel Fattah1 · Mohammed Mostafa El‑Mahy1 · Ahmed Naeem Atiyya1 · Ramy Ahmed Diab1 · Amr Mohamed Aly1 Received: 4 April 2020 / Accepted: 28 August 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose This is a purely observational study with a literature comparison to assess the effectiveness of radial and ulnar arteries propeller perforator-based flaps in post-traumatic soft tissue reconstruction and identify the risk factors for complications. Methods Sixteen patients were involved with post-traumatic wrist and hand soft tissue defects not exceeding 5 × 20 cm. Defects were covered with propeller radial and ulnar arteries perforator-based flaps. Patient demographics, soft tissue defects, complications and clinical outcomes were recorded. Assessment of patients’ satisfaction for donor site morbidity and aesthetic outcome of the flap were performed. Results Radial artery propeller perforator flap was performed in seven cases, and ulnar artery propeller perforator flap was done in nine cases. The size of the skin paddle ranged from 2.5 × 5 cm to 4.5 × 10.5 cm. Primary closure of the donor site was performed in all cases. One flap was lost, while superficial epidermolysis occurred in seven cases (45%). Edge necrosis ranging between 3 and 7 mm occurred in nine cases (60%). Patients’ factors, mode of injury, associated injuries and interval between trauma and coverage were all correlated with complication incidence. The patients’ satisfaction for donor site morbidity was very good and good in 80% of patients, while satisfaction for aesthetic outcome of the flap was very good and good in only 40%. Conclusion Radial and ulnar arteries have reliable perforators for flap elevation, which produce reliable outcome for smalland medium-sized soft tissue reconstruction. Effectiveness decreases in post-traumatic reconstructions. Complications are more frequent in crushing injuries especially if associated with bony fractures. Most complications in trauma cases were attributed to venous congestion, for which supercharging with a vein if accessible to the surgeon is recommended. Keywords Post-traumatic · Perforator flaps · Hand · Wrist · Reconstruction
Introduction Reconstruction of wrist and hand soft tissue defects includes local, pedicled, distant and free flaps. The choice for coverage depends on the size, site and complexity of the wound, health status of the surrounding tissues and of the patient [1]. In 1989, Koshima and Soeda described the first perforator flap based upon a single paraumbilical perforator from the deep inferior epigastric artery [2]. After that, a great interest in propeller flaps for coverage of soft tissue defects was noticed. This may be attributed to the optimal tissue * Amr Mohamed Aly [email protected] 1
Hand and Microsurgery Unit, Orthopaediic Department, Ain Shams University Hospital, Cairo, Egypt
matching replacing like-with-
Data Loading...
