Free radial forearm flap for near total degloving finger reconstruction

Chin-Ta Lin, Shyi-Gen Chen, Tim-Mo Chen, Niann-Tzyy Dai, Yuan-Sheng Tzeng, Shou-Cheng Deng, Chih-Shin Wang, Shun-Cheng Chang

Research output: Contribution to journalArticle

Abstract

Background: Total circumference degloving injury of the digits usually results in a large cutaneous defect with tendinus structure and bone and joint exposure. A thin and adequately sized flap is required when revasculization is not possible to resurface the defect, restore the finger function, and prevent amputation. Materials and Methods: In this report, we present our experience on reconstruction of total circumferential degloving injury on the digits using free radial forearm (RF) flaps in 6 patients. Between February 2006 and January 2011, 6 male patients with circumferential degloving injury of 6 digits underwent reconstruction with the free RF flaps. The average flap size was 15.8×7.1 cm. Donor sites were covered with split-thickness skin graft (STSG). Results: All of flaps survived completely and donor sites healed without complications. The mean follow-up period was 22 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 with an average of 10.2 mm (range, 8-12 mm) and adequate protective sensation. Patient satisfaction for resurfaced digits averaged 9.3 (range, 9-10 mm) on a 10-points visual analogic scale (VAS). Conclusion: In conclusion, the free RF flaps were thin and did not interfere with finger movements. The patients could attain smooth finger contours and acceptable function results after reconstruction. This method may be a valuable alternation for reconstruction of total circumference avulsion injury of the digits. © 2012 JMS.
Original languageEnglish
Pages (from-to)265-270
Number of pages6
JournalJournal of Medical Sciences (Taiwan)
Volume32
Issue number6
Publication statusPublished - 2012
Externally publishedYes

Fingerprint

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

Keywords

  • Degloving digit injury
  • Free radial forearm flap
  • Sensate flap
  • adult
  • article
  • clinical article
  • donor site
  • finger injury
  • follow up
  • free radial forearm flap
  • free tissue graft
  • grip strength
  • hand reconstruction
  • healing
  • human
  • male
  • near total degloving finger reconstruction
  • patient satisfaction
  • pinch strength
  • proprioception
  • scoring system
  • skin flap survival
  • split thickness skin graft
  • total circumference degloving digit injury
  • visual analog scale

Cite this

Lin, C-T., Chen, S-G., Chen, T-M., Dai, N-T., Tzeng, Y-S., Deng, S-C., ... Chang, S-C. (2012). Free radial forearm flap for near total degloving finger reconstruction. Journal of Medical Sciences (Taiwan), 32(6), 265-270.

Free radial forearm flap for near total degloving finger reconstruction. / Lin, Chin-Ta; Chen, Shyi-Gen; Chen, Tim-Mo; Dai, Niann-Tzyy; Tzeng, Yuan-Sheng; Deng, Shou-Cheng; Wang, Chih-Shin; Chang, Shun-Cheng.

In: Journal of Medical Sciences (Taiwan), Vol. 32, No. 6, 2012, p. 265-270.

Research output: Contribution to journalArticle

Lin, C-T, Chen, S-G, Chen, T-M, Dai, N-T, Tzeng, Y-S, Deng, S-C, Wang, C-S & Chang, S-C 2012, 'Free radial forearm flap for near total degloving finger reconstruction', Journal of Medical Sciences (Taiwan), vol. 32, no. 6, pp. 265-270.
Lin C-T, Chen S-G, Chen T-M, Dai N-T, Tzeng Y-S, Deng S-C et al. Free radial forearm flap for near total degloving finger reconstruction. Journal of Medical Sciences (Taiwan). 2012;32(6):265-270.
Lin, Chin-Ta ; Chen, Shyi-Gen ; Chen, Tim-Mo ; Dai, Niann-Tzyy ; Tzeng, Yuan-Sheng ; Deng, Shou-Cheng ; Wang, Chih-Shin ; Chang, Shun-Cheng. / Free radial forearm flap for near total degloving finger reconstruction. In: Journal of Medical Sciences (Taiwan). 2012 ; Vol. 32, No. 6. pp. 265-270.
@article{f4e29cadad82489b8fc06186efb1c5b1,
title = "Free radial forearm flap for near total degloving finger reconstruction",
abstract = "Background: Total circumference degloving injury of the digits usually results in a large cutaneous defect with tendinus structure and bone and joint exposure. A thin and adequately sized flap is required when revasculization is not possible to resurface the defect, restore the finger function, and prevent amputation. Materials and Methods: In this report, we present our experience on reconstruction of total circumferential degloving injury on the digits using free radial forearm (RF) flaps in 6 patients. Between February 2006 and January 2011, 6 male patients with circumferential degloving injury of 6 digits underwent reconstruction with the free RF flaps. The average flap size was 15.8×7.1 cm. Donor sites were covered with split-thickness skin graft (STSG). Results: All of flaps survived completely and donor sites healed without complications. The mean follow-up period was 22 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 with an average of 10.2 mm (range, 8-12 mm) and adequate protective sensation. Patient satisfaction for resurfaced digits averaged 9.3 (range, 9-10 mm) on a 10-points visual analogic scale (VAS). Conclusion: In conclusion, the free RF flaps were thin and did not interfere with finger movements. The patients could attain smooth finger contours and acceptable function results after reconstruction. This method may be a valuable alternation for reconstruction of total circumference avulsion injury of the digits. {\circledC} 2012 JMS.",
keywords = "Degloving digit injury, Free radial forearm flap, Sensate flap, adult, article, clinical article, donor site, finger injury, follow up, free radial forearm flap, free tissue graft, grip strength, hand reconstruction, healing, human, male, near total degloving finger reconstruction, patient satisfaction, pinch strength, proprioception, scoring system, skin flap survival, split thickness skin graft, total circumference degloving digit injury, visual analog scale",
author = "Chin-Ta Lin and Shyi-Gen Chen and Tim-Mo Chen and Niann-Tzyy Dai and Yuan-Sheng Tzeng and Shou-Cheng Deng and Chih-Shin Wang and Shun-Cheng Chang",
note = "Export Date: 21 March 2016 通訊地址: Chang, S.-C.; Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-gong Road, Taipei 114, 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., Gonzales del Pino, J., Controversies in the treatment of fingertip amputations (1998) Clin Orthop, pp. 63-73; Foucher, G., Koury, R.K., Digital reconstruction with hand flaps (1997) Clin Plast Surg, 24, pp. 1-32; 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) BJPS, 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. , In: Green DP, Hotchkiss RN, Pederson WC, Wolfe SW, editors, New York, Churchill Livingstone; 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; 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; Chen, H.C., El-Gammal, T.A., The lateral arm fascial free flap for resurfacing of the hand and fingers (1997) Plast Reconstr Surg, 99, pp. 454-459; 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; 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; 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; 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; Adani, R., Castagnetti, C., Landi, A., Degloving injuries of the hand and fingers (1995) Clin Orthop Relat Res, 314, pp. 19-25; 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; 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; Chia, J., Lim, A., Peng, Y.P., Use of an arterialized venous flap for resurfacing a circumferencial soft tissue defect of a digit (2001) Microsurgery, 21, pp. 374-378",
year = "2012",
language = "English",
volume = "32",
pages = "265--270",
journal = "Journal of Medical Sciences",
issn = "1011-4564",
publisher = "國防醫學院",
number = "6",

}

TY - JOUR

T1 - Free radial forearm flap for near total degloving finger reconstruction

AU - Lin, Chin-Ta

AU - Chen, Shyi-Gen

AU - Chen, Tim-Mo

AU - Dai, Niann-Tzyy

AU - Tzeng, Yuan-Sheng

AU - Deng, Shou-Cheng

AU - Wang, Chih-Shin

AU - Chang, Shun-Cheng

N1 - Export Date: 21 March 2016 通訊地址: Chang, S.-C.; Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-gong Road, Taipei 114, 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., Gonzales del Pino, J., Controversies in the treatment of fingertip amputations (1998) Clin Orthop, pp. 63-73; Foucher, G., Koury, R.K., Digital reconstruction with hand flaps (1997) Clin Plast Surg, 24, pp. 1-32; 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) BJPS, 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. , In: Green DP, Hotchkiss RN, Pederson WC, Wolfe SW, editors, New York, Churchill Livingstone; 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; 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; Chen, H.C., El-Gammal, T.A., The lateral arm fascial free flap for resurfacing of the hand and fingers (1997) Plast Reconstr Surg, 99, pp. 454-459; 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; 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; 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; 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; Adani, R., Castagnetti, C., Landi, A., Degloving injuries of the hand and fingers (1995) Clin Orthop Relat Res, 314, pp. 19-25; 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; 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; Chia, J., Lim, A., Peng, Y.P., Use of an arterialized venous flap for resurfacing a circumferencial soft tissue defect of a digit (2001) Microsurgery, 21, pp. 374-378

PY - 2012

Y1 - 2012

N2 - Background: Total circumference degloving injury of the digits usually results in a large cutaneous defect with tendinus structure and bone and joint exposure. A thin and adequately sized flap is required when revasculization is not possible to resurface the defect, restore the finger function, and prevent amputation. Materials and Methods: In this report, we present our experience on reconstruction of total circumferential degloving injury on the digits using free radial forearm (RF) flaps in 6 patients. Between February 2006 and January 2011, 6 male patients with circumferential degloving injury of 6 digits underwent reconstruction with the free RF flaps. The average flap size was 15.8×7.1 cm. Donor sites were covered with split-thickness skin graft (STSG). Results: All of flaps survived completely and donor sites healed without complications. The mean follow-up period was 22 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 with an average of 10.2 mm (range, 8-12 mm) and adequate protective sensation. Patient satisfaction for resurfaced digits averaged 9.3 (range, 9-10 mm) on a 10-points visual analogic scale (VAS). Conclusion: In conclusion, the free RF flaps were thin and did not interfere with finger movements. The patients could attain smooth finger contours and acceptable function results after reconstruction. This method may be a valuable alternation for reconstruction of total circumference avulsion injury of the digits. © 2012 JMS.

AB - Background: Total circumference degloving injury of the digits usually results in a large cutaneous defect with tendinus structure and bone and joint exposure. A thin and adequately sized flap is required when revasculization is not possible to resurface the defect, restore the finger function, and prevent amputation. Materials and Methods: In this report, we present our experience on reconstruction of total circumferential degloving injury on the digits using free radial forearm (RF) flaps in 6 patients. Between February 2006 and January 2011, 6 male patients with circumferential degloving injury of 6 digits underwent reconstruction with the free RF flaps. The average flap size was 15.8×7.1 cm. Donor sites were covered with split-thickness skin graft (STSG). Results: All of flaps survived completely and donor sites healed without complications. The mean follow-up period was 22 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 with an average of 10.2 mm (range, 8-12 mm) and adequate protective sensation. Patient satisfaction for resurfaced digits averaged 9.3 (range, 9-10 mm) on a 10-points visual analogic scale (VAS). Conclusion: In conclusion, the free RF flaps were thin and did not interfere with finger movements. The patients could attain smooth finger contours and acceptable function results after reconstruction. This method may be a valuable alternation for reconstruction of total circumference avulsion injury of the digits. © 2012 JMS.

KW - Degloving digit injury

KW - Free radial forearm flap

KW - Sensate flap

KW - adult

KW - article

KW - clinical article

KW - donor site

KW - finger injury

KW - follow up

KW - free radial forearm flap

KW - free tissue graft

KW - grip strength

KW - hand reconstruction

KW - healing

KW - human

KW - male

KW - near total degloving finger reconstruction

KW - patient satisfaction

KW - pinch strength

KW - proprioception

KW - scoring system

KW - skin flap survival

KW - split thickness skin graft

KW - total circumference degloving digit injury

KW - visual analog scale

M3 - Article

VL - 32

SP - 265

EP - 270

JO - Journal of Medical Sciences

JF - Journal of Medical Sciences

SN - 1011-4564

IS - 6

ER -