1/17. Cross-hand, cross-finger neurovascular flap: a preliminary report.As a preliminary report we present a case of severe injury of the dominant left hand in a 19-year-old girl. Reconstruction constituted a cross-arm flap initially, a palmaris longus tendon graft and finally a cross-hand, cross-finger neurovascular flap.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
2/17. Optimizing the correction of severe postburn hand deformities by using aggressive contracture releases and fasciocutaneous free-tissue transfers.Severe postburn hand deformities were classified into three major patterns: hyperextension deformity of the metacarpophalangeal joint of the fingers with dorsal contracture of the hand, adduction contracture of the thumb with hyperextension deformity of the interphalangeal joint, and flexion contracture of the palm. Over the past 6 years, 18 cases of severe postburn hand deformities were corrected with extensor tenotomy, joint capsulotomy, and release of volar plate and collateral ligament. The soft-tissue defects were reconstructed with various fasciocutaneous free flaps, including the arterialized venous flap (n = 4), dorsalis pedis flap (n = 3), posterior interosseous flap (n = 3), first web space free flap (n = 3), and radial forearm flap (n = 1). Early active physical therapy was applied. All flaps survived. Functional return of pinch and grip strength was possible in 16 cases. In 11 cases of reconstruction of the dorsum of the hand, the total active range of motion in all joints of the fingers averaged 140 degrees. The mean grip strength was 16.5 kg and key pinch was 3.5 kg. In palm reconstruction, the wider contact area facilitated the grasping of larger objects. In thumb reconstruction, key-pinch increased to 5.5 kg and the angle of the first web space increased to 45 degrees. Jebsen's hand function test was not possible before surgery; postoperatively, it showed more functional recovery in gross motion and in the dominant hand. Aggressive contracture release of the bone,joints, tendons, and soft tissue is required for optimal results in the correction of severe postburn hand deformities. Various fasciocutaneous free flaps used to reconstruct the defect provide early motion, appropriate thinness, and excellent cosmesis of the hand.- - - - - - - - - - ranking = 2keywords = palm (Clic here for more details about this article) |
3/17. Is 20 years of immobilization, not sufficient to render metacarpophalangeal joints completely useless?--Correction of a 20-year old post-burn palmar contracture: a case report.This report presents a case of post-burn palmar contracture with flexion contracture of thumb of 20-year duration. The contracture was released and the raw area was covered with split thickness skin graft. Only one 'K' wire in soft tissue was needed to keep all the fingers straight and immobilized, suggestive of intermetacarpal ligamentous contracture. A static night splint was given to maintain the correction. Complete range of movement was achieved in a month with the combination of dynamic splinting and physiotherapy. It was interesting to note that even 20 years of contracted position did not render the metacarpophalangeal joints completely stiff and useless. Probable reasons are discussed.- - - - - - - - - - ranking = 5keywords = palm (Clic here for more details about this article) |
4/17. 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) |
5/17. Crack hands: a dermatologic effect of smoking crack cocaine.We have seen multiple cases of a characteristic skin lesion produced by smoking crack cocaine. We describe a typical case with photographs demonstrating multiple blackened hyperkeratotic lesions of the palmar aspects of the fingers and palm, some linear, some circular. These involve mostly the dominant hand and are caused by the heat of the glass cocaine pipe.- - - - - - - - - - ranking = 2keywords = palm (Clic here for more details about this article) |
6/17. Use of dorsal ulnar neurocutaneous island flap in the treatment of chronic postburn palmar contractures.In the present study, the authors evaluated efficiency of the "dorsal ulnar neurocutaneous island flap" in the coverage of palmar defects resulting from radical release of selected chronic postburn contractures. Eight white male hands with palmar contracture were treated with this flap between November 2001 and December 2003. The mean follow-up period was 11.6 months. The flap, which was planned on the ulnar aspect of the forearm and the hand, is transferred to the palmar defect. The subcutaneous pedicle of the flap was skin-grafted to avoid tension. All operations were successful. Distal flap necrosis that healed by secondary intention was observed in one of the eight flaps. Seventy-five degrees was the maximum improvement in metacarpophalangeal (MP) joint extension achieved in the little finger. Grasp function of the hand dramatically improved and the bulk of the flap did not interfere with grasping. No recurrent palmar contracture was observed. The authors concluded that the dorsoulnar neurocutaneous island flap can be used effectively in the treatment of postburn palmar contractures. The safety of the flap can be enhanced by grafting the intervening skin between the pivot point of the flap and the palmar defect.- - - - - - - - - - ranking = 10keywords = palm (Clic here for more details about this article) |
7/17. Hand reconstruction using the thin anterolateral thigh flap.BACKGROUND: Perforator flaps have been introduced for various kinds of reconstruction and resurfacing; in particular, the free thin anterolateral thigh flap is becoming one of the most preferred options for reconstruction of soft-tissue defects. methods: Between 1999 and 2002, the authors used this flap as a free flap for nine cases for covering hand defects after burn, crushing injuries, or severe scar contracture release. There were eight men and one woman, the mean age of the patients was 31 years, and the size of the flaps ranged from 7 x 3.5 cm to 15 x 9 cm; thinning was performed in all flaps. RESULTS: All flaps survived completely, and the donor site was closed directly in seven cases; in two cases, the exposed muscle was covered with split-thickness skin graft. CONCLUSIONS: The anterolateral thigh flap was thin enough for defects on the dorsum and/or palm of the hand and for first web reconstruction after scar contracture release. It has many advantages in free flap surgery including a long pedicle with a suitable vessel diameter, and the donor-site morbidity is acceptable. The thin anterolateral thigh flap is a versatile soft-tissue flap that achieves good hand contour with low donor-site morbidity.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
8/17. Total palmar resurfacing with scapular free flap in a 26-year contracted hand.The scapular free flap offers a large-sized and well-vascularized coverage for variable defects. It is not regarded, however, as a favorite tool for palmar resurfacing because of its bulky and rigid nature. A 28-year-old man had sustained a contact dermal injury at the age of 2 years that resulted in a severely deformed hand. The total palmar defect was resurfaced by surgical intervention with a scapular free flap. After secondary procedures, the final result was promising. The present report focuses on the secondary procedures, which make a more functional and aesthetically pleasing hand after coverage with the scapular flap. Also, our result suggests that even finger joints contracted for 26 years can recover motion if they have not been directly damaged.- - - - - - - - - - ranking = 6keywords = palm (Clic here for more details about this article) |
9/17. The use of the free parascapular flap in midpalmar soft tissue defect.Clinical applications of a new free flap are presented. The parascapular flap is a cutaneous unit whose blood supply is provided by a posterior branch of the inferior scapular artery. It is a safe and relatively large flap (approximately 8 by 12 cm or more) with a constant pedicle. It has no sensory nerve. The donor site is easy to close directly. As suggested by Baudet, we think it is useful in reconstruction of the palm and, in some cases, the dorsum of the hand.- - - - - - - - - - ranking = 5keywords = palm (Clic here for more details about this article) |
10/17. A dorsal flap with lateral digital extensions for palmar web contractures.A dorsal flap with lateral digital extensions for correction of palmer web contractures following burns is described. Two cases, one with multiple web-contractures, are presented.- - - - - - - - - - ranking = 5keywords = palm (Clic here for more details about this article) |
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