1/2. Resurfacing of a totally degloved hand using thin perforator-based cutaneous free flaps.Resurfacing after a total degloving injury to the hand is one of the most difficult management problems in hand surgery. Although there are many methods of managing this type of injury that preserve functions and lessen deformities, none provides a satisfactory solution to this problem. The authors resurfaced a totally degloved hand using extremely thin and broad perforator-based cutaneous free flaps, and the donor defects were covered with split-thickness skin grafts. The postoperative course was uneventful, the flaps survived completely, and the grafts took without loss. Several minor operations, including interdigitation, defatting, and the formation of palmar and digital creases, were required to obtain the final appearance and function of the hand. Eighteen months after the initial operation, the patient could pick up a bean with a pair of chopsticks. sensation was satisfactory in the palm 20 months after the initial operation, as evidenced by 10 mm of static two-point discrimination. To reconstruct a total and complete skin defect of the hand, the authors recommend that thin perforator-based cutaneous free flaps be an initial consideration.- - - - - - - - - - ranking = 1keywords = discrimination (Clic here for more details about this article) |
2/2. Sensibility of finger fillet flaps on late follow-up evaluation.Though the use of fillet flaps salvaged from damaged digits is a well-established technique to obtain soft tissue coverage for the badly injured hand, the sensibility of these flaps has not been evaluated. We examined a series of four patients who underwent digital fillet flaps following hand trauma. Static two-point discrimination measurements of the injured hand and the contralateral hand showed that all four patients retained sensibility in the fillet flap that was equal to or better than the intact skin surrounding the flap. In some cases, the sensibility of the flap was equal to the sensibility in the corresponding contralateral fingertips. No patients had complaints regarding the function of their fillet flaps as sensate coverage of major soft tissue defects.- - - - - - - - - - ranking = 1keywords = discrimination (Clic here for more details about this article) |