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Thought you might appreciate this item s I saw at Plastic and Reconstructive Surgery. Send a copy to your email. Some error has occurred while processing your request. Please try after some time. Article as PDF Pederson, William C. Upper Extremity Microsurgery. Plastic and Reconstructive Surgery 6 , May Add Item s to:. An Existing Folder. A New Folder. The item s has been successfully added to " ". Thanks for registering! Be sure to verify your new user account in the next 24 hours, by checking your email and clicking the "verify" link. This article has been saved into your User Account, in the Favorites area, under the new folder " ".
C, D A parascapular fasciocutaneous flap is designed and harvested to provide soft tissue coverage of the hand defect. E The final results at 1-year follow-up illustrated good form and function.
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Fascial flaps have a distinct advantage over other flaps because they are very thin and pliable. Tendons can be sandwiched between folded fascia to permit glide yet avoid the bulk of other flaps. For these reasons, fascial flaps have become ideal coverage for soft tissue defects for both the extensor and flexor surfaces of the hand. A split-thickness skin graft or full-thickness skin graft is required to cover the fascia for definitive closure.
This necessitates the second donor site. The donor site from where the fascia flap was harvested is closed primarily without tension. This limited donor-site morbidity also makes fascial flaps rather appealing. Technically, any fasciocutaneous flap could be subdivided into its fascial and cutaneous components. This means the number of fascial flaps would be at least that of their fasciocutaneous counterparts. The temporal parietal flap is widely used for soft tissue coverage of the hand and forearm.
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Additionally, the temporal parietal fascial flap can be harvested with a deeper branch of the superficial temporal vessels, the middle temporal vessels, along with a deep temporal fascia so that a sandwich type of fascial flap can be elevated. The donor site is well hidden by the hair. To limit donor-site scarring, this fascial flap has been elevated reliably with endoscopic assistance using a 4-cm preauricular incision. A year-old woman sustained significant burns to her hands and face. A The contracting to the back of the hand was released exposing the extensor tendons.
B, C A temporal parietal fascia flap was designed and elevated for closure. D The final result of the healed hand. Five other fascial flaps were widely used for reconstruction of the upper extremity: the scapular fascia flap, anterolateral thigh fascia flap, the serratus anterior fascia flap, the radial forearm fascia flap, and the lateral arm fascia flap. The scapular fascia flap is reliably elevated on the large-caliber circumflex scapular vessels and can be used to cover the entire dorsum or volar aspect of the hand.
At times, the lateral position of the patient can hinder simultaneous operating on the affected upper extremity. The anterolateral thigh fascial flap has several advantages over other fascial flaps.
Microvascular Reconstruction of the Upper Extremity
An extremely large area of fascia on the anterolateral thigh can be harvested on this pedicle. One disadvantage of the anterolateral thigh fascial flap is that the main pedicle may course through the vastus lateralis muscle sending perforators out into the fascia. This is only considered a disadvantage if the surgeon is not interested in performing at perforator fascial flap as it necessitates meticulous and sometimes tedious dissection through the vastus lateralis muscle. The serratus anterior fascia flap has gained popularity for coverage of soft tissue defects in the hand because of its reliable blood supply, minimal and rather inconspicuous donor site, and ease of dissection.
The serratus anterior fascia flap has been used with great success over exposed extensor and flexor tendons of the hand, permitting excellent tendon excursion and maintenance of total active range of motion Fig. The serratus anterior fascia flap has advantages of having a very long pedicle of large caliber with a very versatile size of the fascia. Care must be taken during the dissection of this flap to avoid injury to the long thoracic nerve creating a palsy of the serratus muscle.
A, B A dorsal hand defect in a year-old woman; extensor tendons are exposed. C, D A serratus anterior fascia provides thin coverage to the tendons. A split thickness skin graft STSG is placed on the fascia. E, F The final results at 1-year follow-up illustrating good form and function.
A—C A year-old woman with an avulsion injury to the right palm. Radial debridement is performed prior to definitive closure.
D A serratus anterior free fascia flap is used for thin coverage. E—H The final result at 5-year follow-up. Good contour and function are provided. The radial forearm fascial flap can be harvested as a distally based, pedicled flap supplied by the ulnar artery. This flap, however, is reliant on an intact palmar arch and ulnar artery. An Allen's test is performed to ensure patency of the ulnar artery and palmar arch.
The radial forearm fascia flap can also be harvested as a free flap based on the radial artery proximally. Many surgeons, however, may be reluctant to use a flap from the nontraumatized forearm to reconstruct the contralateral, traumatized upper extremity. The lateral arm fascia flap is based on the posterior radial collateral artery, a terminal branch of the profunda brachii artery.
The advantage of this flap is that can be harvested from the same limb as a soft tissue defect without compromise to function. The radial nerve is extremely intimate with the posterior radial collateral artery and must be protected during the dissection. Venous flaps use superficial veins and overlying skin to provide soft tissue coverage of small defects of the hand and fingers.
For extensor surfaces, this flap has a proximal and distal vein anastomosed to veins on the back of the hand or finger. As a pure venous flap, perfusion is obtained through partially deoxygenated blood.
Unfortunately, these flaps are not as reliable as standard flaps due to the lack of normal physiologic blood flow; that is, arterial inflow to the capillary bed to the venous outflow infrastructure. Many of the free flaps listed above can be harvested with more than one type of tissue. The fibula osteocutaneous flap represents the most commonly used composite tissue where bone and skin are required Fig. The skin paddle can vary in size but may be taken as large as 10 to 18 cm centered over the middle third of the fibula.
A—C A year-old woman sustained a gunshot injury to the right forearm.modernpsychtraining.com/cache/current/cufal-what-is-the.php
Microvascular Reconstruction of the Upper Extremity | SpringerLink
A segmental loss of ulna was observed. A soft tissue defect and loss of flexor tendons were also observed. D The wounds were debrided.
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