1/37. Fingertip reconstruction with flaps and nail bed grafts.We retrospectively reviewed the cases of 14 fingertips reconstructed with a combination of local or regional flaps and nail bed grafts, some of which were placed wholly or partially over a de-epithelialized flap. Most of the fingertips sustained a crushing injury and were reconstructed at the time of the injury. Soft tissue coverage was provided by palmar V-Y flaps in 6 cases, thenar flaps in 4, lateral V-Y flaps in 2, a Moberg flap in 1, and a cross-finger flap in 1. Split toenail bed grafts were used in 6 cases, full-thickness nail bed grafts from the amputated part in 6, and split nail bed grafts from the injured digit in 2. There was 1 partial graft loss and 1 partial flap loss. The remaining cases had completely successful grafts and good soft tissue healing. Subsequent nail growth and adherence were good in all but the 1 digit requiring secondary composite grafting.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
2/37. A reverse ulnar hypothenar flap for finger reconstruction.A reverse-flow island flap from the hypothenar eminence of the hand was applied in 11 patients to treat palmar skin defects, amputation injuries, or flexion contractures of the little finger. There were three female and eight male patients, and their ages at the time of surgery averaged 46 years. A 3 x 1.5 to 5 X 2 cm fasciocutaneous flap from the ulnar aspect of the hypothenar eminence, which was located over the abductor digiti minimi muscle, was designed and transferred in a retrograde fashion to cover the skin and soft-tissue defects of the little finger. The flap was based on the ulnar palmar digital artery of the little finger and in three patients was sensated by the dorsal branch of the ulnar nerve or by branches of the ulnar palmar digital nerve of the little finger. Follow-up periods averaged 42 months. The postoperative course was uneventful for all patients, and all of the flaps survived without complications. The donor site was closed primarily in all cases, and no patient complained of significant donor-site problems. Satisfactory sensory reinnervation was achieved in patients who underwent sensory flap transfer, as indicated by 5 mm of moving two-point discrimination. A reverse island flap from the hypothenar eminence is easily elevated, contains durable fasciocutaneous structures, and has a good color and texture match to the finger pulp. This flap is a good alternative for reconstruction of palmar skin and soft-tissue defects of the little finger.- - - - - - - - - - ranking = 4keywords = palm (Clic here for more details about this article) |
3/37. Use of the distally-based radial forearm flap supplied by the dorsal carpal arch, or palmar carpal arch, or both, in mutilating injuries. Two case report.The distally-based radial forearm flap is safe, easy, and versatile as a regional, one-stage procedure to reconstruct soft tissue defects of the hand. However, there is a general perception that the deep and superficial palmar arches have to be intact to raise a distally-based radial forearm flap. We successfully used two flaps supplied by the dorsal carpal arch, or the palmar carpal arch, or both, despite the fact that the deep and the superficial palmar arches were damaged in mutilating injuries.- - - - - - - - - - ranking = 7keywords = palm (Clic here for more details about this article) |
4/37. Reversed dorsal digital and metacarpal island flaps supplied by the dorsal cutaneous branches of the palmar digital artery.The dorsal digital and metacarpal island flaps have been described for use in a variety of clinical situations. On the basis of the authors' previous angiographic studies, these two skin flaps were planned on the dorsum of the proximal phalanx or intermetacarpal space based on the vascular anastomoses between the proximal dorsal cutaneous branches of the palmar digital artery and the dorsal digital branches of the dorsal metacarpal artery at the level of the proximal phalanx. The authors present a series of 13 patients using these flaps. To reconstruct the injured finger pulp, the reverse dorsal digital flap was used in 5 patients, and the reverse dorsal metacarpal flap was used in 8 patients. Most of the 13 patients sustained a work-related injury. Associated injuries of bone, joint, or tendon occurred in most patients. In all patients, the skin defect was located distal to the proximal interphalangeal joint. The skin paddle was taken from the dorsal aspect of the middle and ring fingers or the first, second, third, and fourth metacarpal area. All flaps survived completely. Two patients who had the dorsal branch of the sensitive radial nerve anastomosed to the digital nerve recovered 6-mm two-point discrimination in the reverse dorsal digital flap. The results of this anatomic study and the authors' clinical experience confirm the reliability of the dorsal digital and metacarpal island flaps.- - - - - - - - - - ranking = 5keywords = palm (Clic here for more details about this article) |
5/37. Free temporoparietal fascial flap for coverage of a large palmar forearm wound after hand replantation.A free temporoparietal fascial flap with a split-thickness skin graft was used to cover a large palmar forearm wound in a patient whose hand had been replanted 21 days earlier after traumatic amputation at the distal forearm level. At a 39-month follow-up, the patient had achieved an excellent cosmetic and functional result, with no alopecia or facial nerve injury. The flap is advantageous for coverage of wounds that require a large amount of thin, pliable tissue, and it leaves a concealed donor-site scar.- - - - - - - - - - ranking = 5keywords = palm (Clic here for more details about this article) |
6/37. Fingertip reconstruction using a volar flap based on the transverse palmar branch of the digital artery.A new homodigital neurovascular island flap for fingertip reconstruction, called a volar digital island flap, is described. The flap is perfused from the proper digital artery through the transverse palmar branch, and is drained through the tiny venules and capillaries contained in the perivascular soft tissue. Between 1997 and 2000, 25 fingers from 23 patients with defects of the middle and distal phalangeal areas were reconstructed using this flap. All flaps survived well. Patient age ranged from 17 to 65 years (average age, 32.5 years). Long-term follow-up for more than 6 months was possible in 15 fingers from 14 patients. light touch and temperature sensation could be detected in all the flaps evaluated. The mean value of the static two-point discrimination test was 4.2 mm. Although this flap requires the sacrifice of important volar skin, it provides excellent padding and sensation for fingertip reconstruction. The authors think that this new flap is an alternative choice for coverage of fingertip defects.- - - - - - - - - - ranking = 5keywords = palm (Clic here for more details about this article) |
7/37. Reconstruction of an amputated fingertip by a prefabricated free volar forearm flap.An amputated fingertip was banked temporarily under the skin of the volar wrist. This prefabricated fingertip was transferred back to the finger 2 months later, together with a free flap from the volar wrist based on the superficial palmar branch of the radial artery. The fingertip pulp showed a little pale pigmentation, but maintained its length well. The dorsal tip of the finger looked normal. This two-stage procedure made it possible to salvage the amputated bone and nail.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
8/37. Repair of avulsion injury of the whole hand with single-stage transfer of five combined tissues: case report.The authors present a 32-year-old man with an entire left hand avulsion injury. This was repaired in one stage with five free-tissue transfers, a combination of a left hallux wrap-around flap for thumb reconstruction, bilateral second toes for middle and ring finger reconstruction, and bilateral femoral anterolateral flaps for coverage of the injured hand at the palmar and dorsal aspects. All the transfers survived uneventfully. Due to enlargement of the flaps and narrowness of the first web space, three further surgical procedures were subsequently carried out. Over a 2-year follow-up, a satisfactory appearance of the reconstructed hand and functional restoration were obtained.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
9/37. replantation of multi-level fingertip amputation using the pocket principle (palmar pocket method).Two cases of multi-level fingertip amputation are presented. In each case, replantation was achieved in a two-stage procedure, involving reattachment, de-epithelialisation and insertion into a palmar pocket in stage 1, followed by removal from the palmar pocket 16 days later. The cases are described and the technique is discussed.- - - - - - - - - - ranking = 6keywords = palm (Clic here for more details about this article) |
10/37. Palmar advancement flap with V-Y closure for thumb tip injuries.The palmar advancement flap with V-Y closure was used in two patients with thumb tip injuries. This technique allows more distal advancement of the flap than does a conventional palmar advancement flap and does not require skin graft coverage.- - - - - - - - - - ranking = 2keywords = palm (Clic here for more details about this article) |
| | Next -> |