Reconstruction of complete circumferential degloving injury of a digit with a sensate medial sural artery perforator flap

Chin-Ta Lin, Kuang-Ling Ou, Shyi-Gen Chen, Tim-Mo Chen, Shun-Cheng Chang

Research output: Contribution to journalArticle

Abstract

Complete circumferential degloving injury of the digits usually results in a large cutaneous defect with tendinous structures, 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. This report presents our experience with reconstruction of the entire circumferential degloving injury of the digit using a free sensate medial sural artery (MSA) perforator flap. The donor site was covered with split-thickness skin graft (STSG) and healed without complications. Furthermore, the MSA flap was thin and did not interfere with finger movements. The patients could attain smooth finger contours, acceptable function results, and adequate protective sensation after reconstruction. Patient satisfaction for the resurfaced digit scored 9 on a 10-point visual analogic pain intensity scale. This method may provide a valuable alternative for reconstruction of entire circumferential avulsion injury of the digit. © 2013 JMS.
Original languageEnglish
Pages (from-to)357-360
Number of pages4
JournalJournal of Medical Sciences (Taiwan)
Volume33
Issue number6
DOIs
Publication statusPublished - 2013
Externally publishedYes

Fingerprint

Perforator Flap
Fingers
Arteries
Skin
Patient Satisfaction
Amputation
Joints
Tissue Donors
Transplants
Bone and Bones
Pain
Wounds and Injuries
sural
Degloving Injuries

Keywords

  • Degloving injury
  • Digit
  • Free medial sural flap
  • Sensate flap
  • adult
  • article
  • case report
  • end to end anastomosis
  • finger amputation
  • finger injury
  • human
  • human tissue
  • index finger
  • male
  • radial artery
  • radial nerve
  • sensate medial sural artery perforator flap
  • skin sensation
  • sural nerve
  • tissue flap
  • vascular pedicle

Cite this

Reconstruction of complete circumferential degloving injury of a digit with a sensate medial sural artery perforator flap. / Lin, Chin-Ta; Ou, Kuang-Ling; Chen, Shyi-Gen; Chen, Tim-Mo; Chang, Shun-Cheng.

In: Journal of Medical Sciences (Taiwan), Vol. 33, No. 6, 2013, p. 357-360.

Research output: Contribution to journalArticle

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title = "Reconstruction of complete circumferential degloving injury of a digit with a sensate medial sural artery perforator flap",
abstract = "Complete circumferential degloving injury of the digits usually results in a large cutaneous defect with tendinous structures, 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. This report presents our experience with reconstruction of the entire circumferential degloving injury of the digit using a free sensate medial sural artery (MSA) perforator flap. The donor site was covered with split-thickness skin graft (STSG) and healed without complications. Furthermore, the MSA flap was thin and did not interfere with finger movements. The patients could attain smooth finger contours, acceptable function results, and adequate protective sensation after reconstruction. Patient satisfaction for the resurfaced digit scored 9 on a 10-point visual analogic pain intensity scale. This method may provide a valuable alternative for reconstruction of entire circumferential avulsion injury of the digit. {\circledC} 2013 JMS.",
keywords = "Degloving injury, Digit, Free medial sural flap, Sensate flap, adult, article, case report, end to end anastomosis, finger amputation, finger injury, human, human tissue, index finger, male, radial artery, radial nerve, sensate medial sural artery perforator flap, skin sensation, sural nerve, tissue flap, vascular pedicle",
author = "Chin-Ta Lin and Kuang-Ling Ou and Shyi-Gen Chen and Tim-Mo Chen 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; Ishiko, T., Nakaima, N., Suzuki, S., Free posterior interosseous artery perforator flap for finger reconstruction (2009) J Plast Reconstr Aesthet Surg, 62, pp. e211-215. , doi: 10.1016/j.bjps.2009.01.065; 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 J Reconstr Microsurg 2000, 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. , doi: 10.1097/ TA.0b013e318203179e; 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. , doi: 10.1002/micr.20650; 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. , doi: 10.1002/ micr.20777; Wang, X., Mei, J., Pan, J., Chen, H., Zhang, W., Tang, M., Reconstruction of distal limb defects with the free medial sural artery perforator flap (2013) Plast Reconstr Surg, 131, pp. 95-105. , doi: 10.1097/ PRS.0b013e3182729e3c; 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; 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 DP, Hotchkiss RN, Pederson WC, Wolfe SW, editors, 5th ed. New York: Churchill Livingstone; 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; Koshima, I., Soeda, S., Inferior epigastric artery skin flaps without rectus abdominis muscle (1989) Br J Plast Surg, 42, pp. 645-648; Koshima, I., Fukuda, H., Utunomiya, R., Soeda, S., The anterolateral thigh flap: Variations in its vascular pedicle (1989) Br J Plast Surg, 42, pp. 260-262; Chen, S.L., Yu, C.C., Chang, M.C., Deng, S.C., Wu, Y.S., Chen, T.M., Medial sural artery perforator flap for intraoral reconstruction following cancer ablation (2008) Ann Plast Surg, 61, pp. 274-279. , doi: 10.1097/ SAP.0b013e318157a1a0; Cavadas, P.C., Sanz-Gimenez-Rico, J.R., Gutierrez-De la camara, A., Navarro-Monzon{\'i}s, A., Soler-Nomdedeu, S., Mart{\'i}nez-Soriano, F., The medial sural artery perforator free flap (2001) Plast Reconstr Surg, 108, pp. 1609-1615",
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doi = "10.6136/JMS.2013.33(6).357",
language = "English",
volume = "33",
pages = "357--360",
journal = "Journal of Medical Sciences",
issn = "1011-4564",
publisher = "國防醫學院",
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}

TY - JOUR

T1 - Reconstruction of complete circumferential degloving injury of a digit with a sensate medial sural artery perforator flap

AU - Lin, Chin-Ta

AU - Ou, Kuang-Ling

AU - Chen, Shyi-Gen

AU - Chen, Tim-Mo

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; Ishiko, T., Nakaima, N., Suzuki, S., Free posterior interosseous artery perforator flap for finger reconstruction (2009) J Plast Reconstr Aesthet Surg, 62, pp. e211-215. , doi: 10.1016/j.bjps.2009.01.065; 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 J Reconstr Microsurg 2000, 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. , doi: 10.1097/ TA.0b013e318203179e; 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. , doi: 10.1002/micr.20650; 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. , doi: 10.1002/ micr.20777; Wang, X., Mei, J., Pan, J., Chen, H., Zhang, W., Tang, M., Reconstruction of distal limb defects with the free medial sural artery perforator flap (2013) Plast Reconstr Surg, 131, pp. 95-105. , doi: 10.1097/ PRS.0b013e3182729e3c; 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; 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 DP, Hotchkiss RN, Pederson WC, Wolfe SW, editors, 5th ed. New York: Churchill Livingstone; 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; Koshima, I., Soeda, S., Inferior epigastric artery skin flaps without rectus abdominis muscle (1989) Br J Plast Surg, 42, pp. 645-648; Koshima, I., Fukuda, H., Utunomiya, R., Soeda, S., The anterolateral thigh flap: Variations in its vascular pedicle (1989) Br J Plast Surg, 42, pp. 260-262; Chen, S.L., Yu, C.C., Chang, M.C., Deng, S.C., Wu, Y.S., Chen, T.M., Medial sural artery perforator flap for intraoral reconstruction following cancer ablation (2008) Ann Plast Surg, 61, pp. 274-279. , doi: 10.1097/ SAP.0b013e318157a1a0; Cavadas, P.C., Sanz-Gimenez-Rico, J.R., Gutierrez-De la camara, A., Navarro-Monzonís, A., Soler-Nomdedeu, S., Martínez-Soriano, F., The medial sural artery perforator free flap (2001) Plast Reconstr Surg, 108, pp. 1609-1615

PY - 2013

Y1 - 2013

N2 - Complete circumferential degloving injury of the digits usually results in a large cutaneous defect with tendinous structures, 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. This report presents our experience with reconstruction of the entire circumferential degloving injury of the digit using a free sensate medial sural artery (MSA) perforator flap. The donor site was covered with split-thickness skin graft (STSG) and healed without complications. Furthermore, the MSA flap was thin and did not interfere with finger movements. The patients could attain smooth finger contours, acceptable function results, and adequate protective sensation after reconstruction. Patient satisfaction for the resurfaced digit scored 9 on a 10-point visual analogic pain intensity scale. This method may provide a valuable alternative for reconstruction of entire circumferential avulsion injury of the digit. © 2013 JMS.

AB - Complete circumferential degloving injury of the digits usually results in a large cutaneous defect with tendinous structures, 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. This report presents our experience with reconstruction of the entire circumferential degloving injury of the digit using a free sensate medial sural artery (MSA) perforator flap. The donor site was covered with split-thickness skin graft (STSG) and healed without complications. Furthermore, the MSA flap was thin and did not interfere with finger movements. The patients could attain smooth finger contours, acceptable function results, and adequate protective sensation after reconstruction. Patient satisfaction for the resurfaced digit scored 9 on a 10-point visual analogic pain intensity scale. This method may provide a valuable alternative for reconstruction of entire circumferential avulsion injury of the digit. © 2013 JMS.

KW - Degloving injury

KW - Digit

KW - Free medial sural flap

KW - Sensate flap

KW - adult

KW - article

KW - case report

KW - end to end anastomosis

KW - finger amputation

KW - finger injury

KW - human

KW - human tissue

KW - index finger

KW - male

KW - radial artery

KW - radial nerve

KW - sensate medial sural artery perforator flap

KW - skin sensation

KW - sural nerve

KW - tissue flap

KW - vascular pedicle

U2 - 10.6136/JMS.2013.33(6).357

DO - 10.6136/JMS.2013.33(6).357

M3 - Article

VL - 33

SP - 357

EP - 360

JO - Journal of Medical Sciences

JF - Journal of Medical Sciences

SN - 1011-4564

IS - 6

ER -