The free fillet flap after traumatic amputation: a review of literature and case report
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The free fillet flap after traumatic amputation: a review of literature and case report Jacques A. Machol IV & Robert C. Fang & Hani S. Matloub
# American Association for Hand Surgery 2013
Abstract Severe, mutilating hand injuries present difficult reconstructive scenarios. Often in these cases, portions of the amputated tissue may be used for reconstruction of the remaining digits and hand using the spare parts principle. The free fillet flap follows the spare parts concept. A literature review of free fillet flaps for hand and forearm coverage is provided. We also present a case report of a multi-digit and dorsal hand free fillet flap for coverage of a traumatic metacarpal hand. This flap demonstrates the value of ingenuity in planning during emergent trauma reconstruction. Keywords Microsurgery . Trauma . Fillet flap . Free filet flap . Review
Introduction Upper extremity injuries have a devastating impact on the workforce in the USA and are a significant cause of J. A. Machol IV : H. S. Matloub Department of Plastic Surgery, The Medical College of Wisconsin, 8700 Watertown Plank Road, Milwaukee, WI 53226-3595, USA J. A. Machol IV e-mail: [email protected] H. S. Matloub (*) Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA e-mail: [email protected] R. C. Fang Department of Surgery, Division of Plastic Surgery, Emory University School of Medicine, 550 Peachtree St., SE, 8th Floor, STE. 4300, Atlanta, GA 30308, USA e-mail: [email protected]
morbidity. According to the US Bureau of Labor Statistics in 2010, the incidence of upper extremity injuries requiring time off work was 25.1 per 10,000 full-time employees. The median time lost from work was a notable 7 days [24]. Similarly, severe, mutilating hand injuries present a difficult reconstructive challenge, as critical tissues such as bone and soft tissue are often lacking. Thus, conservation of these structures is essential. Preservation of length and function is paramount, but this must also be weighed against adequate coverage, especially in the case of a mangled hand. Parallel to the pedicled groin flap, first described by McGregor and Jackson in 1972, a generous skin paddle is often required for coverage of such large defects [20]. Local and regional soft tissue options include a variety of pedicled cutaneous, fasciocutaneous, adipofascial flaps, and even skin or composite grafting [3, 7, 14, 17, 25]. Free tissue transfer is another weapon in the surgical armamentarium. It is not commonly used in an emergent setting, but Brooks et al. describe using a free arterialized venous flap from an amputated part after partial hand amputation [5]. Furthermore, a solitary degloving of the hand is rare, but Adani et al. also describe successful microvascular replantation of the skin [1]. The free fillet flap is an analogous “spare parts” concept that has been described by the senior author (H.M.) for proximal upper extremity coverage after trauma [10]. The pedicled digital fillet flap has also been extensively describe
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