2006 - UZ Leuven

transposition 0/30°/60°, PIP-to-MP-transposition 0/20°/80° and MP-to-MP-transposition 0/20°/57°. The results after microvascular PIP-jointtransfer from the 2 nd toe for PIP-joint reconstruction were 0/25°/58° forPIP-joint reconstruction and 0/15°/70° for MP-joint reconstruction.Arthritic changes could be seen in 3 out of 4 patients with partialvascularized joint transfer. In all complete joint transfers there was noclinical and radiological evidence of arthritis even after 15 years. In thetwo skeletal immature patients at the time of transfer, normal growthcompared to the contralateral donor site could be seen. In 8 out of 14patients complications occurred.Conclusions: Indications for vascularized joint transfer at the finger inchildren is set because of lack of therapy option offering normalgrowth potential. In adults vascularized joint transfer is indicated incase of contraindication for prosthetic joint replacement or arthrodesis.HIERNER R., NIJS S., VAN DEN KERCKHOVE E.: Possibilities andresults of defect coverage at the elbow. J. Hand Surg., 2006; 31B: 88.Background: Large defects at the elbow region often lead tosignificant impairment of function.Patients and methods: In a retrospective clinical study 151 patients(82 male, 59 female) who underwent flap surgery for defectreconstruction at the elbow were reviewed. The age ranged from 7 –82 (average 39,4) years. The defect was located in 49 cases at thefossa cubitalis, in 15 cases at the medial epicondyle region, in 29cases at the lateral epicondyle region and in the remaining 61 casesat the dorsal region or involved multiple regions. Etiology of defectwas trauma (n = 95), impaired wound healing and infections (n= 27),extravasation injuries (n = 12), unstable scare after multiple previoussurgeries (n = 8) and revision after ulnar nerve decompression at theelbow. Defect coverage was done using local flaps (n = 71), pedicledflaps (n = 41) and free microvascular flaps (n = 39). Study criteriaswere successful defect coverage and active and passive ROM preandpostoperatively.Results: Successful primary reconstruction could be achieved in 142cases (93,6%). There were 2 complete and 4 partial flap necrosis afterlocal flap transfer. And 3 after free microvascular transfer. There wereno changes in ROM depending on the flap reconstruction unless ascar release had been carried out.Conclusion: Reconstruction of large defects at the elbow do require amultidisciplinary approach. For the treatment of large soft tissuedefects we are using a standardized diagnostic and therapeuticschedule. We distinguish 4 functional units (fossa cubitalis, lateralepicondyle unit, dorsal unit (regio olecrani) and medial epicondyleunit, thus defects can be classified into monoregional and polyregional82