Hand Dorsum Reconstruction: The Usefulness of Flaps and Regenerative Surgery Through a Retrospective Analysis of Ten Years Work of a Hand Surgery Department.
Andrea Marchesini, MD; Pierfrancesco Pugliese, MD; Pier Paolo Pangrazi, MD; Letizia Senesi, MD; Michele Riccio, Professor
A.O.U. Ospedali Riuniti di Ancona, Ancona, Italy
The loss of substance in the hand dorsum can be classified as simple or complex. In the first case only the skin is involved while two or more tissues are involved in the second case. Such tissutal losses are likely to impose severe deficit to patients as they limit the ability of wrist and fingers extension which is a biomechanically essential functional task in order to grant a proper hand's grip. Due to the importance of such functional area various authors proposed and largely employed a 'one stage functional reconstruction' in the multi-tissutal loss of substance by means free or pedicled composite flap [1-2]. Such treatments have been integrated, in the last years, by the use of dermal substituted and more recently by new methods of regenerative surgery [3]. Authors propose a review of their cases which reveals a treatment flowchart allowing for a reduction of the costs associated to the reconstruction for the patients involved.
Authors provide a review of cases treated at their unit from 2006 to 2016. The sample is made of 40 patients of which 14 received a one-stage reconstruction of the hand dorsum by means of a radial forearm composite free flap, 2 were treated with free ALT flap, 8 were treated with pedicled radial forearm flap and the remaining 16 had their hand dorsum reconstructed with dermal substituted and regenerative surgery. Valuations are based on the number of surgical procedures that patients received, the numbers of days they were at hospital, and the quality of their functional recovery in terms of TAM, sensitivity, Quick-Dash e Posas score.
From our preliminary results all patients were satisfied with their reconstruction and recovered a good or excellent function a part from two cases of poor recovery. Based on the results a treatment flowchart will be proposed which merges traditional and innovative reconstructive techniques depending on the specific tissue involved in the loss of substance.
[1]Reid CD, Moss LH. One-stage flap repair with vascularized tendon grafts in a dorsal hand injury using the "Chinese" forearm flap. Br J Plast Surg 1983;36:473-9.
[2] Caroli A, Adani R et al. Dorsalis pedis flap with vascularized extensor tendons for dorsal hand reconstruction. Plast Reconstr Surg 1993;92:1326-30.
[3] Adani R, Rossati L et al. Use of integra artificial dermis to reduce donor site morbidity after pedicle flaps in hand surgery. J Hand Surg Am. 2014 Nov;39(11):2228-34.
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