Free fasciocutaneous flaps for reconstruction of complete circumferential degloving injury of digits

Chin-Ta Lin, Shyi-Gen Chen, Tim-Mo Chen, Niann-Tzyy Dai, Shun-Cheng Chang

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Complete circumferential degloving injury of the digits usually results in a large cutaneous defect with tendinous structure and bone and joint exposure. When revascularization is not possible, a thin and adequately sized flap is required to resurface the defect, restore finger function, and prevent amputation. In this report, we present our experience with reconstruction of the entire circumferential degloving injury of the digits using free fasciocutaneous flaps. Between February 2006 and January 2011, 9 male patients with circumferential degloving injury of 9 digits underwent reconstruction using free fasciocutaneous flap transfer with the posterior interosseous artery flap, medial sural artery flap, anteromedial thigh flap, or radial forearm flap. The average flap size was 14.2 × 6.9 cm. Donor sites were closed primarily or covered with split-thickness skin graft. All flaps survived completely and the donor sites healed without complications. The mean follow-up period was 34.8 months. A maximum Kapandji score (10/10) was seen in 2 cases with crushed thumbs. All patients could achieve good key pinch and grasping functions. All skin flaps showed acceptable static 2-point discrimination and adequate protective sensation. Patient satisfaction for resurfaced digits averaged 9 on a 10-points visual analogic scale. In conclusion, the free fasciocutaneous flaps used were thin and did not interfere with finger movements. The patient's finger formed a smooth contour and acceptable functional results were obtained after reconstruction. This method may be a valuable alternative for reconstruction of entire circumferential avulsion injury of the digits. © 2012 Wiley Periodicals, Inc.
Original languageEnglish
Pages (from-to)191-197
Number of pages7
JournalMicrosurgery
Volume33
Issue number3
DOIs
Publication statusPublished - 2013
Externally publishedYes

Fingerprint

Free Tissue Flaps
Fingers
Skin
Arteries
Tissue Donors
Thumb
Thigh
Patient Satisfaction
Amputation
Forearm
Joints
Transplants
Bone and Bones
Wounds and Injuries
Degloving Injuries

Keywords

  • adult
  • anterolateral thigh flap
  • article
  • clinical article
  • controlled study
  • donor site
  • fasciocutaneous flap
  • finger
  • finger injury
  • follow up
  • hand function
  • hand reconstruction
  • human
  • interphalangeal joint
  • male
  • patient satisfaction
  • pinch strength
  • priority journal
  • proximal interphalangeal joint
  • radial forearm flap
  • skin flap
  • split thickness skin graft
  • Adult
  • Fascia
  • Finger Injuries
  • Free Tissue Flaps
  • Humans
  • Male
  • Middle Aged
  • Reconstructive Surgical Procedures
  • Skin Transplantation
  • Young Adult

Cite this

Free fasciocutaneous flaps for reconstruction of complete circumferential degloving injury of digits. / Lin, Chin-Ta; Chen, Shyi-Gen; Chen, Tim-Mo; Dai, Niann-Tzyy; Chang, Shun-Cheng.

In: Microsurgery, Vol. 33, No. 3, 2013, p. 191-197.

Research output: Contribution to journalArticle

Lin, Chin-Ta ; Chen, Shyi-Gen ; Chen, Tim-Mo ; Dai, Niann-Tzyy ; Chang, Shun-Cheng. / Free fasciocutaneous flaps for reconstruction of complete circumferential degloving injury of digits. In: Microsurgery. 2013 ; Vol. 33, No. 3. pp. 191-197.
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abstract = "Complete circumferential degloving injury of the digits usually results in a large cutaneous defect with tendinous structure and bone and joint exposure. When revascularization is not possible, a thin and adequately sized flap is required to resurface the defect, restore finger function, and prevent amputation. In this report, we present our experience with reconstruction of the entire circumferential degloving injury of the digits using free fasciocutaneous flaps. Between February 2006 and January 2011, 9 male patients with circumferential degloving injury of 9 digits underwent reconstruction using free fasciocutaneous flap transfer with the posterior interosseous artery flap, medial sural artery flap, anteromedial thigh flap, or radial forearm flap. The average flap size was 14.2 × 6.9 cm. Donor sites were closed primarily or covered with split-thickness skin graft. All flaps survived completely and the donor sites healed without complications. The mean follow-up period was 34.8 months. A maximum Kapandji score (10/10) was seen in 2 cases with crushed thumbs. All patients could achieve good key pinch and grasping functions. All skin flaps showed acceptable static 2-point discrimination and adequate protective sensation. Patient satisfaction for resurfaced digits averaged 9 on a 10-points visual analogic scale. In conclusion, the free fasciocutaneous flaps used were thin and did not interfere with finger movements. The patient's finger formed a smooth contour and acceptable functional results were obtained after reconstruction. This method may be a valuable alternative for reconstruction of entire circumferential avulsion injury of the digits. {\circledC} 2012 Wiley Periodicals, Inc.",
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author = "Chin-Ta Lin and Shyi-Gen Chen and Tim-Mo Chen and Niann-Tzyy Dai and Shun-Cheng Chang",
note = "被引用次數:9 Export Date: 21 March 2016 CODEN: MSRGD 通訊地址: Chang, S.-C.; Department of Surgery, National Defense Medical Center, Tri-Service General Hospital, No. 325, Section 2, Cheng-Gung Road, Taipei 11490, Taiwan; 電子郵件: aarondakimo@yahoo.com.tw 參考文獻: Urbaniak, J.R., Evans, J.P., Bright, D.S., Microvascular management of ring avulsion injuries (1981) J Hand Surg, 6, pp. 25-30; Beasley, R.W., Principles of soft tissue replacement for the hand (1983) J Hand Surg, 8, pp. 781-784; Martin, C., Gonz{\'a}lez Del Pino, J., Controversies in the treatment of fingertip amputations. Conservative versus surgical reconstruction (1998) Clin Orthop Relat Res, 353, pp. 63-73; Foucher, G., Koury, R.K., Digital reconstruction with hand flaps (1997) Clin Plast Surg, 24, pp. 1-32; Ishiko, T., Nakaima, N., Suzuki, S., Free posterior interosseous artery perforator flap for finger reconstruction (2009) J Plast Reconstr Aesthet Surg, 62, pp. e211-e215; Chen, S.L., Chou, G.H., Chen, T.M., Wang, H.J., Salvage of completely degloved finger with a posterior interosseous free flap (2001) Br J Plast Surg, 54, pp. 69-71; Adani, R., Castagnetti, C., Landi, A., Degloving injuries of the hand and fingers (1995) Clin Orthop Relat Res, 314, pp. 19-25; Yamauchi, T., Yajima, H., Kizaki, K., Kobata, Y., Fukui, A., Tamai, S., Sensory reconstruction in sensate radial forearm flap transfer (2000) J Reconstr Microsurg, 16, pp. 593-595; Yu, P., Selber, J., Perforator patterns of the anteromedial thigh flap (2011) Plast Reconstr Surg, 128, pp. 151e-157e; Lin, C.H., Lin, C.H., Lin, Y.T., Hsu, C.C., Ng, T.W., Wei, F.C., The medial sural artery perforator flap: A versatile donor site for hand reconstruction (2011) J Trauma, 70, pp. 736-743; Inigo, F., Gargollo, C., Secondary coverage of the hand using a dorsalis pedis plus first web space free flap (1992) J Reconstr Microsurg, 8, pp. 461-465; Woo, S.H., Choi, B.C., Oh, S.J., Seul, J.H., Classification of the first web space free flap of the foot and its applications in reconstruction of the hand (1999) Plast Reconstr Surg, 103, pp. 508-517; Javaid, M., Cormack, G.C., Anterolateral thigh free flap for complex soft tissue hand reconstructions (2003) J Hand Surg, 28 B, pp. 21-27; Ulrich, D., Pallua, N., Treatment of avulsion injury of three fingers with a compound thoracodorsal artery perforator flap including serratus anterior fascia (2009) Microsurgery, 29, pp. 556-559; Atzei, A., Pignatti, M., Udali, G., Cugola, L., Maranzano, M., The distal lateral arm flap for resurfacing of extensive defects of the digits (2007) Microsurgery, 27, pp. 8-16; Chai, Y.M., Wang, C.Y., Wen, G., Zeng, B.F., Cai, P.H., Han, P., Combined medialis pedis and medial plantar fasciocutaneous flaps based on the medial plantar pedicle for reconstruction of complex soft tissue defects in the hand (2011) Microsurgery, 31, pp. 45-50; Logan, A., Elliot, D., Foucher, G., Free toe pulp transfer to restore traumatic digital pulp loss (1985) Br J Plast Surg, 38, pp. 497-500; Morrison, W.A., Thumb and fingertip reconstruction by composite microvascular tissue from the toes (1992) Hand Clin, 8, pp. 537-550; Rui, Y., Mi, J., Shi, H., Zhang, Z., Yan, H., Free great toe wrap-around flap combined with second toe medial flap for reconstruction of completely degloved fingers (2010) Microsurgery, 30, pp. 449-456; Lin, C.H., Mardini, S., Lin, Y.T., Lin, C.H., Chen, C.T., Wei, F.C., Osteoplastic thumb ray restoration with or without secondary toe transfer for reconstruction of opposable basic hand function (2008) Plast Reconstr Surg, 121, pp. 1288-1297; Adani, R., Busa, R., Castagnetti, C., Castagnini, L., Caroli, A., Replantation of degloved skin of the hand (1998) Plast Reconstr Surg, 101, pp. 1544-1551; Tremolada, C., Ponzielli, P., Candiani, P., Donati, L., The subcutaneous laterodigital reverse flap (1998) Plast Reconstr Surg, 101, pp. 1070-1074; Adani, R., Marcoccio, I., Tarallo, L., Fregni, U., The reverse heterodigital neurovascular island flap for digital pulp reconstruction (2005) Tech Hand Up Extrem Surg, 9, pp. 91-95; Vuppalapati, G., Oberlin, C., Balakrishnan, G., Distally based dorsal hand flaps: Clinical experience, cadaveric studies and an update (2004) Br J Polit Sci, 57, pp. 653-667; Chuang, D.C., Colony, L.H., Chen, H.C., Wei, F.C., Groin flap design and versatility (1989) Plast Reconstr Surg, 84, pp. 100-107; Yamada, N., Ui, K., Uchinuma, E., The use of a thin abdominal flap in degloving finger injuries (2001) Br J Plast Surg, 54, pp. 434-438; Lee, W.P.A., Salyapongse, A.N., Thumb reconstruction (2005) Green's Operative Hand Surgery, pp. 1865-1912. , Green D.P. Hotchkiss R.N. Pederson W.C. Wolfe S.W. editors. 5th ed. New York: Churchill Livingstone;; O'Brien, B.M., Shanmugan, N., Experimental transfer of composite free flaps with microvascular anastomoses (1973) Aust N Z J Surg, 43, pp. 285-288; Gang, R.K., The Chinese forearm flap in reconstruction of the hand (1990) J Hand Surg Br, 15, pp. 84-88; Jones, N.F., Jarrahy, R., Kaufman, M.R., Pedicled and free radial forearm flaps for reconstruction of the elbow, wrist, and hand (2008) Plast Reconstr Surg, 121, pp. 887-898; Galpern, D.W., Tsai, T.M., Multiple toe transfer and sensory free flap use after a traumatic amputation of multiple digits. Surgery done in a single setting: A case study (2011) Mcrosurgery, 31, pp. 484-489; Kao, H.K., Chang, K.P., Wei, F.C., Cheng, M.H., Comparison of the medial sural artery perforator flap with the radial forearm flap for head and neck reconstructions (2009) Plast Reconstr Surg, 124, pp. 1125-1132; Chi, Z., Gao, W., Yan, H., Li, Z., Chen, X., Zhang, F., Reconstruction of totally degloved fingers with a spiraled parallelogram medial arm free flap (2012) J Hand Surg Am, 37, pp. 1042-1050",
year = "2013",
doi = "10.1002/micr.22064",
language = "English",
volume = "33",
pages = "191--197",
journal = "Microsurgery",
issn = "0738-1085",
publisher = "Wiley-Liss Inc.",
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TY - JOUR

T1 - Free fasciocutaneous flaps for reconstruction of complete circumferential degloving injury of digits

AU - Lin, Chin-Ta

AU - Chen, Shyi-Gen

AU - Chen, Tim-Mo

AU - Dai, Niann-Tzyy

AU - Chang, Shun-Cheng

N1 - 被引用次數:9 Export Date: 21 March 2016 CODEN: MSRGD 通訊地址: Chang, S.-C.; Department of Surgery, National Defense Medical Center, Tri-Service General Hospital, No. 325, Section 2, Cheng-Gung Road, Taipei 11490, Taiwan; 電子郵件: aarondakimo@yahoo.com.tw 參考文獻: Urbaniak, J.R., Evans, J.P., Bright, D.S., Microvascular management of ring avulsion injuries (1981) J Hand Surg, 6, pp. 25-30; Beasley, R.W., Principles of soft tissue replacement for the hand (1983) J Hand Surg, 8, pp. 781-784; Martin, C., González Del Pino, J., Controversies in the treatment of fingertip amputations. Conservative versus surgical reconstruction (1998) Clin Orthop Relat Res, 353, pp. 63-73; Foucher, G., Koury, R.K., Digital reconstruction with hand flaps (1997) Clin Plast Surg, 24, pp. 1-32; Ishiko, T., Nakaima, N., Suzuki, S., Free posterior interosseous artery perforator flap for finger reconstruction (2009) J Plast Reconstr Aesthet Surg, 62, pp. e211-e215; Chen, S.L., Chou, G.H., Chen, T.M., Wang, H.J., Salvage of completely degloved finger with a posterior interosseous free flap (2001) Br J Plast Surg, 54, pp. 69-71; Adani, R., Castagnetti, C., Landi, A., Degloving injuries of the hand and fingers (1995) Clin Orthop Relat Res, 314, pp. 19-25; Yamauchi, T., Yajima, H., Kizaki, K., Kobata, Y., Fukui, A., Tamai, S., Sensory reconstruction in sensate radial forearm flap transfer (2000) J Reconstr Microsurg, 16, pp. 593-595; Yu, P., Selber, J., Perforator patterns of the anteromedial thigh flap (2011) Plast Reconstr Surg, 128, pp. 151e-157e; Lin, C.H., Lin, C.H., Lin, Y.T., Hsu, C.C., Ng, T.W., Wei, F.C., The medial sural artery perforator flap: A versatile donor site for hand reconstruction (2011) J Trauma, 70, pp. 736-743; Inigo, F., Gargollo, C., Secondary coverage of the hand using a dorsalis pedis plus first web space free flap (1992) J Reconstr Microsurg, 8, pp. 461-465; Woo, S.H., Choi, B.C., Oh, S.J., Seul, J.H., Classification of the first web space free flap of the foot and its applications in reconstruction of the hand (1999) Plast Reconstr Surg, 103, pp. 508-517; Javaid, M., Cormack, G.C., Anterolateral thigh free flap for complex soft tissue hand reconstructions (2003) J Hand Surg, 28 B, pp. 21-27; Ulrich, D., Pallua, N., Treatment of avulsion injury of three fingers with a compound thoracodorsal artery perforator flap including serratus anterior fascia (2009) Microsurgery, 29, pp. 556-559; Atzei, A., Pignatti, M., Udali, G., Cugola, L., Maranzano, M., The distal lateral arm flap for resurfacing of extensive defects of the digits (2007) Microsurgery, 27, pp. 8-16; Chai, Y.M., Wang, C.Y., Wen, G., Zeng, B.F., Cai, P.H., Han, P., Combined medialis pedis and medial plantar fasciocutaneous flaps based on the medial plantar pedicle for reconstruction of complex soft tissue defects in the hand (2011) Microsurgery, 31, pp. 45-50; Logan, A., Elliot, D., Foucher, G., Free toe pulp transfer to restore traumatic digital pulp loss (1985) Br J Plast Surg, 38, pp. 497-500; Morrison, W.A., Thumb and fingertip reconstruction by composite microvascular tissue from the toes (1992) Hand Clin, 8, pp. 537-550; Rui, Y., Mi, J., Shi, H., Zhang, Z., Yan, H., Free great toe wrap-around flap combined with second toe medial flap for reconstruction of completely degloved fingers (2010) Microsurgery, 30, pp. 449-456; Lin, C.H., Mardini, S., Lin, Y.T., Lin, C.H., Chen, C.T., Wei, F.C., Osteoplastic thumb ray restoration with or without secondary toe transfer for reconstruction of opposable basic hand function (2008) Plast Reconstr Surg, 121, pp. 1288-1297; Adani, R., Busa, R., Castagnetti, C., Castagnini, L., Caroli, A., Replantation of degloved skin of the hand (1998) Plast Reconstr Surg, 101, pp. 1544-1551; Tremolada, C., Ponzielli, P., Candiani, P., Donati, L., The subcutaneous laterodigital reverse flap (1998) Plast Reconstr Surg, 101, pp. 1070-1074; Adani, R., Marcoccio, I., Tarallo, L., Fregni, U., The reverse heterodigital neurovascular island flap for digital pulp reconstruction (2005) Tech Hand Up Extrem Surg, 9, pp. 91-95; Vuppalapati, G., Oberlin, C., Balakrishnan, G., Distally based dorsal hand flaps: Clinical experience, cadaveric studies and an update (2004) Br J Polit Sci, 57, pp. 653-667; Chuang, D.C., Colony, L.H., Chen, H.C., Wei, F.C., Groin flap design and versatility (1989) Plast Reconstr Surg, 84, pp. 100-107; Yamada, N., Ui, K., Uchinuma, E., The use of a thin abdominal flap in degloving finger injuries (2001) Br J Plast Surg, 54, pp. 434-438; Lee, W.P.A., Salyapongse, A.N., Thumb reconstruction (2005) Green's Operative Hand Surgery, pp. 1865-1912. , Green D.P. Hotchkiss R.N. Pederson W.C. Wolfe S.W. editors. 5th ed. New York: Churchill Livingstone;; O'Brien, B.M., Shanmugan, N., Experimental transfer of composite free flaps with microvascular anastomoses (1973) Aust N Z J Surg, 43, pp. 285-288; Gang, R.K., The Chinese forearm flap in reconstruction of the hand (1990) J Hand Surg Br, 15, pp. 84-88; Jones, N.F., Jarrahy, R., Kaufman, M.R., Pedicled and free radial forearm flaps for reconstruction of the elbow, wrist, and hand (2008) Plast Reconstr Surg, 121, pp. 887-898; Galpern, D.W., Tsai, T.M., Multiple toe transfer and sensory free flap use after a traumatic amputation of multiple digits. Surgery done in a single setting: A case study (2011) Mcrosurgery, 31, pp. 484-489; Kao, H.K., Chang, K.P., Wei, F.C., Cheng, M.H., Comparison of the medial sural artery perforator flap with the radial forearm flap for head and neck reconstructions (2009) Plast Reconstr Surg, 124, pp. 1125-1132; Chi, Z., Gao, W., Yan, H., Li, Z., Chen, X., Zhang, F., Reconstruction of totally degloved fingers with a spiraled parallelogram medial arm free flap (2012) J Hand Surg Am, 37, pp. 1042-1050

PY - 2013

Y1 - 2013

N2 - Complete circumferential degloving injury of the digits usually results in a large cutaneous defect with tendinous structure and bone and joint exposure. When revascularization is not possible, a thin and adequately sized flap is required to resurface the defect, restore finger function, and prevent amputation. In this report, we present our experience with reconstruction of the entire circumferential degloving injury of the digits using free fasciocutaneous flaps. Between February 2006 and January 2011, 9 male patients with circumferential degloving injury of 9 digits underwent reconstruction using free fasciocutaneous flap transfer with the posterior interosseous artery flap, medial sural artery flap, anteromedial thigh flap, or radial forearm flap. The average flap size was 14.2 × 6.9 cm. Donor sites were closed primarily or covered with split-thickness skin graft. All flaps survived completely and the donor sites healed without complications. The mean follow-up period was 34.8 months. A maximum Kapandji score (10/10) was seen in 2 cases with crushed thumbs. All patients could achieve good key pinch and grasping functions. All skin flaps showed acceptable static 2-point discrimination and adequate protective sensation. Patient satisfaction for resurfaced digits averaged 9 on a 10-points visual analogic scale. In conclusion, the free fasciocutaneous flaps used were thin and did not interfere with finger movements. The patient's finger formed a smooth contour and acceptable functional results were obtained after reconstruction. This method may be a valuable alternative for reconstruction of entire circumferential avulsion injury of the digits. © 2012 Wiley Periodicals, Inc.

AB - Complete circumferential degloving injury of the digits usually results in a large cutaneous defect with tendinous structure and bone and joint exposure. When revascularization is not possible, a thin and adequately sized flap is required to resurface the defect, restore finger function, and prevent amputation. In this report, we present our experience with reconstruction of the entire circumferential degloving injury of the digits using free fasciocutaneous flaps. Between February 2006 and January 2011, 9 male patients with circumferential degloving injury of 9 digits underwent reconstruction using free fasciocutaneous flap transfer with the posterior interosseous artery flap, medial sural artery flap, anteromedial thigh flap, or radial forearm flap. The average flap size was 14.2 × 6.9 cm. Donor sites were closed primarily or covered with split-thickness skin graft. All flaps survived completely and the donor sites healed without complications. The mean follow-up period was 34.8 months. A maximum Kapandji score (10/10) was seen in 2 cases with crushed thumbs. All patients could achieve good key pinch and grasping functions. All skin flaps showed acceptable static 2-point discrimination and adequate protective sensation. Patient satisfaction for resurfaced digits averaged 9 on a 10-points visual analogic scale. In conclusion, the free fasciocutaneous flaps used were thin and did not interfere with finger movements. The patient's finger formed a smooth contour and acceptable functional results were obtained after reconstruction. This method may be a valuable alternative for reconstruction of entire circumferential avulsion injury of the digits. © 2012 Wiley Periodicals, Inc.

KW - adult

KW - anterolateral thigh flap

KW - article

KW - clinical article

KW - controlled study

KW - donor site

KW - fasciocutaneous flap

KW - finger

KW - finger injury

KW - follow up

KW - hand function

KW - hand reconstruction

KW - human

KW - interphalangeal joint

KW - male

KW - patient satisfaction

KW - pinch strength

KW - priority journal

KW - proximal interphalangeal joint

KW - radial forearm flap

KW - skin flap

KW - split thickness skin graft

KW - Adult

KW - Fascia

KW - Finger Injuries

KW - Free Tissue Flaps

KW - Humans

KW - Male

KW - Middle Aged

KW - Reconstructive Surgical Procedures

KW - Skin Transplantation

KW - Young Adult

U2 - 10.1002/micr.22064

DO - 10.1002/micr.22064

M3 - Article

VL - 33

SP - 191

EP - 197

JO - Microsurgery

JF - Microsurgery

SN - 0738-1085

IS - 3

ER -