Versatility of Fenestrated Groin Flap in the Reconstruction of Post-Burn Dorsal Contractures of Thumb (original) (raw)
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In many settings, microsurgery is not yet common practice for hand injuries. In settings where it is current practice, the patient’s health condition can sometimes be a contraindication. In this case, the pedicled groin flap may be a reliable option for hand surgeons. Information was retrieved from the medical charts of five patients treated with a pedicled groin flap at our National Centre for Burn, Plastic and Reconstructive Surgery between 1st January 2013 and 1st July 2015. We documented socio-demographic features, defect characteristics (aetiology, size), post-operative complications, outcome, and patient satisfaction with cosmetic appearance and donor site scar. There were two cases of burn scar release, two cases of traumatic hand injury, and one case of squamous cell carcinoma excision. There was one distal ischemia of the flap and one flap requiring secondary thinning. All the patients were very satisfied with the donor site scar, which was easily hidden in underwear. Four patients were very satisfied with the reconstructed hand. Despite the current trend towards free tissue transfer, the pedicled groin flap continues to be regarded as a safe, easy and reliable option for the reconstruction of soft tissue defects, and remains widely used.
Composite Osteocutaneous Groin Flap Combined With Neurovascular Island Flap For Thumb Reconstruction
The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 2003
Three amputated thumbs were reconstructed with a composite osteocutaneous groin flap and a neurovascular island flap. The average age at the time of surgery was 28 (range 25-35) years. The level of the amputation was distal to metacarpophalangeal joint in two cases and proximal in one case. The injury mechanism was avulsion in all cases. The postoperative follow-up periods ranged from 27 to 30 months. There were no cases of skin necrosis, bone resorption or infection. Radiographs and three-phase bone scans showed union of the iliac bone block and the stump without any resorption in all three patients. This surgical procedure is reliable and simple and the functional results are satisfying. We reserve this technique for the treatment of thumb amputations which cannot be replanted, particularly as it does not result in bone resorption.
Groin Flap Experience in the Reconstruction of Soft Tissue Defects of the Hand
Turkish Journal of Plastic Surgery / Türk Plastik, Rekonstrüktif ve Estetik Cerrahi Dergisi, 2016
Objective: Pediculated groin flap has been playing an important role in hand reconstructive surgery for a long time. In this study, the cases where pediculated groin flap in the reconstruction of soft tissue defects of the hand was used are presented in terms of literature. Material and Methods: The cases included in the study where a groin flap was used for hand defects between 2010 and 2014 in the Plastic, Reconstructive, and Aesthetic Surgery Department. The age, gender, reason of defect, its localization, groin flap size, donor area closure method, flap separation time, other treatments, and complications were thoroughly examined. Results: Twenty-two groin flaps were used in 13 male and 7 females. It was used to close the amputated part in 8 patients as a result of finger amputation and degloving injury, in 3 patients as a result of hand and finger crush defect, in 1 patient as a result of burn finger defect, in 5 patients for extension contracture, and in 3 patients for flexion contracture due to burn sequel. Flap loss was not recorded in any of the cases. Conclusion: Pediculated groin flap is a good alternative that can be easily and safely used in suitable cases and has an important place in the reconstruction of hand defects.
2019
Background: Square flap theoretically offers 2.82 times increase in the length of contracted surface as compared to maximum of 2.23 times of z-plasties. Aim: To assess the effectiveness of this technique for the most critical first web-space contracture, this study is done to find its efficacy. Methods: Case series was done in department of plastic surgery, JHL. 30 patients with first web-space contractures were included. Pre and post angle and length, and efficacy, as determined by post op angle of ≥ 90o, were recorded. Mean and standard deviation of numerical variables while frequency and percentages of qualitative variables were calculated. Data stratification and post stratification chi-square test was applied to check effect modifier. Results: Mean age was 17.90± 9.271 years. Male patients were 19, while female were 11. Mean duration of contracture was 1.523±0.424 years. Mean pre-operative length was 2.330 ± 0.4921 cm, while post-operative length was 4.470 ± 0.8579 cm. Mean pos...
Skin Graft Versus Local Flaps in Management of Post-burn Elbow Contracture
Cureus, 2021
Introduction Contracture is a pathological scar tissue resulting from local skin tissue damage, secondary to different local factors. It can restrict joint mobility, resulting in deformity and disability. This study aimed to investigate the outcomes of skin grafts compared to local flaps to reconstruct post-burn elbow contractures. These parameters included regaining function, range of movement, recurrence, and local wound complications. Methodology A retrospective study reviewed 21 patients for elbow reconstruction over 12 months. Only patients with post-burn elbow contracture were included. Other causes, including previous corrective surgery, associated elbow stiffness, and patients who opted out of post-operative physiotherapy, were excluded. Patients were categorized according to the method of coverage into three groups: graft alone (G1), local flap (G2), or combined approach (G3). Results Females were three times at higher risk to suffer a burn injury, while almost half of the cases were children. Scald injury represented 81% of burn causes. G1,2,3 were used in 47.6%, 42.9% and 9.5% of cases retrospectively. The overall rate of infection was 28.6%. Hundred percent graft taken was recorded in 83.3 % of cases; however, flap take was 91.1%. After 12 months of follow-up, re-contracture was 60% and 22.8% in G1 and G2; however, the satisfaction rate was 70% and 100% in both groups retrospectively. The overall satisfaction was 85.7% in all groups. Conclusion Grafts and local flaps are reasonable options for post contracture release; however, flaps are superior. Coverage selection depends on the lost tissue area and exposure of underlying deep structures. Physiotherapy and patient satisfaction are crucial in the outcomes.
Groin Flap: A Good Converge for Hand
2006
Summary: Fifty cases of hand trauma of different aetiology with soft tissue loss with exposed tendons and bones were treated in NITOR and DMCH, Dhaka between January '97 and December '02 with groin flap. Eighty three percent (83%) cases have good results with excellent flap adhesion and no flap loss. Seventeen percent (17%) cases have some degree of flap loss
Groin Flap: A Good Converge for Hand Injury
Journal of Medicine, 2008
Fifty cases of hand trauma of different aetiology with soft tissue loss with exposed tendons and bones were treated in NITOR and DMCH, Dhaka between January '97 and December '02 with groin flap. Eighty three percent (83%) cases have good results with excellent flap adhesion and no flap loss. Seventeen percent (17%) cases have some degree of flap loss which were taken to be acceptable. Overall result in terms of restoring the hand function was encouraging which was approximately eighty eight percent (88%). Â DOI = 10.3329/jom.v7i1.1357 J MEDICINE 2006; 7 : 15-19
Cross-finger Flap to the Thumb: Quest for an Alternate Donor
Indian Journal of Plastic Surgery, 2020
Background Distal thumb injuries are managed by multiple local and regional flaps. The cross-finger flap (CFF) is one versatile flap used to cover such defects. The donor finger to the thumb is classically described to be the index finger (IF). However, with the index finger being the second most important finger, it causes further debilitation of the already injured hand. Our aim was to find an alternate donor finger to spare the index finger. Methods and Materials A prospective observational study was conducted on 10 patients with distal thumb injuries who were admitted between November 2018 and July 2019. Ring finger (RF) was used as donor for CFF in all the cases. The subjects were assessed for first web space angle, Kapandji score, total range of movement (TRM) of long fingers, and global hand function using Michigan hand outcome questionnaire (MHQ) after flap division. Results There was no first web contracture and TRM of IF remained unaffected. However, TRM of RF was significantly reduced. But this being a relatively unimportant finger, there was no significant reduction in global hand function, as evaluated by the MHQ score. Conclusion The ring finger is a good alternative for index finger as donor for CFF to the thumb, because it provides adequate tissue along with comfortable positioning and easy maintenance of local hygiene. Moreover, it preserves global hand function by sparing the IF.