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Functional Reconstruction of the Digit with Palmaris Longus Tendocutaneous Arterialized Venous Free Flaps
Sang-Hyun Woo, MD, PhD1; Young-Keun Lee, MD, PhD2; Ho-Jun Cheon, MD1; Young-Woo Kim1
1Cheon & Woo's Institute for Hand & Reconstructive Microsurgery, W Hospital, Daegu, South Korea; 2Dason Orthopedic Clinic, Jeonju, South Korea

Introduction: Clinical application of the venous flap was very limited because of unpredictable necrosis and postoperative swelling. It had been used to recover the small-sized defect of the fingers and hands. In cases of complex defects of flexor, extensor or collateral ligament of the digits with soft tissue defect, the authors reconstructed the digits with palmaris longus tendocutaneous arterialized venous free flaps(PTAVF). We would like to introduce our technique for achieving functional recovery of the digits as well as indications of this procedure.

Materials and Methods: This study is based on 29 cases of PTAVFs harvested from the ipsilateral wrist and forearm for the reconstruction of compound defect of the digits. During the period of last 18 years, the authors performed PTAVF in 17 cases of compound defects of extensor tendon on dorsum of the digits. In 7 cases, collateral ligament of the proximal or distal interphalangeal joint was reconstructed with PTAVF. And, in 5 cases of flexor tendon defect with soft tissue defect on the palmar aspect of the digits, tendocutaneous flaps were used to restore the defect. Flaps were dissected superior to the muscle fascia and included palmaris longus tendon as well as the skin and subcutaneous tissues with veins. After all dissection of venous pedicle, palmaris longus tendon was cut proximally enough. And then, holding of the proximal end of the palmaris longus tendon, flap was undermined distally. The tendons were meticulously dissected to avoid injury to the paratenon and peritendinous tissues between tendon and overlying skin flap. Usually distal part of tendon was cut at the distal crease of the wrist. Survival rate of the PTAVFs and functional recovery of the digits were assessed.

Result: Complete survival was achieved in 27 cases. In one case, flap was lost totally, in another one case, 50% area was necrosed. Secondary skin graft was added in partial necrotic part. In reconstruction of collateral ligament of interphalangeal joint of the thumb and digits, there was no instability in all 7 cases. In cases of extensor defect, extension lag and range of motion was acceptable. Mean active range of motion of affected joint in reconstruction of flexor tendon was 35 degrees.

Conclusion: Palmaris longus tendocutaneous arterialized venous free flaps are very useful for reconstruction of complex defect of the digits with extensor or flexor tendons as well as collateral ligaments.

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