AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...

Prevention of First Web Retraction in Traumatic Cases with Emergency Buried Free Flaps
Institution where the work was prepared: Clinica Aston, Valencia, Spain
Pedro C. Cavadas, MD, PhD; Clinica Aston
Background:
Crush injuries to the hand often result in hydraulic extrusion of the muscles of the first web. This injury, although deceivingly benign is a high-energy injury, since extremely
high instant hydraulic pressure is needed for the skin to break and allow muscle extrusion. If untreated, it leads to severe adduction retraction of the first metacarpal.
Material and Methods:
15 cases of crush injury to the first web with hydraulic extrusion of the muscles (adductor pollicis and 1st dorsal interosseous) were treated in 14 patients. The
muscles of the first web were radically debrided and a free flap was transferred to fill the dead space within the web as an emergency. The flaps used were 5
segmental distal gracilis, three segmental distal sartorious, four saphenous subcutaneous flaps and three subcutaneous lateral arm flaps.
Results:
all 15 flaps were viable. The 1st web remained soft and fully mobile without adduction retraction. Thirteen patients returned to their previous employment.
Conclusion:
muscle debridement and filling of the first web with a free flap in an emergency basis is effective in preventing adduction retraction in crush injuries with hydraulic
muscle extrusion of the 1st web of the hand. The subcutaneous lateral arm free flap is favoured since it allows the procedure to be performed under axilary block.
Arterial Reconstruction for Ulnar Artery Thrombosis
Institution where the work was prepared: Wake Forest University School of Medicine, Winston-Salem, NC, USA
G.D. Chloros, MD; Robert M. Lucas; Martha Holden; L. Andrew Koman; Wake Forest University School of Medicine
Introduction:
The purpose is to evaluate the results of surgical reconstruction of ulnar artery occlusive disease. Materials and
Methods:
This is a retrospective study of 15 patients (all male, mean age 43.6 years, range 28 – 59) with symptomatic post-traumatic occlusive disease of the ulnar artery
(pure hypothenar hammer syndrome) who were treated with reversed interpositional vein grafting from the ulnar artery to the superficial palmar arch. Patients
with concomitant systemic diseases were excluded. All patients were evaluated pre-operatively and at final follow-up using the following health-related quality
of life outcome instruments (HRQL): 1) McCabe cold sensitivity severity scale, 2) McGill pain scale, 3) Levine symptom and function scale and 4) WFU symptom
scale that evaluates pain, numbness and cold intolerance. In addition, digital microvascular perfusion testing (Laser Dopplex Fluxmetry-LDF and Isolated
Cold Stress Testing-ICST) was performed pre-operatively and at final follow-up in 24 of the 36 patients. Finally, all patients were evaluated for graft patency
as determined by Allen's testing and Doppler ultrasound.
Results:
All patients were evaluated for graft patency at a mean of 50.2 months (range 12 – 159) after surgery and all but one vascular grafts were patent. Microvascular
perfusion was evaluated at a mean of 52.2 months (range, 12 - 142) and there was statistically significant improvement in all HRQL instrument scores and
microvascular perfusion results, except for the LDF which showed no statistically significant change. Conclusion: Successful arterial reconstruction in symptomatic
ulnar artery thrombosis decreases symptoms, improves function and has a positive effect on the health-related quality of life.
A Multicenter Study on the Use of Free Flaps to Preserve Upper Extremity Amputation Levels
Institution where the work was prepared: Duke University Medical Center, Durham, NC, USA
Alessio Baccarani, MD1; Keith E. Follmar1; Giorgio De Santis, Professor2; Roberto Adani2; Massimo Pinelli2; Marco Innocenti, MD3; Steffen P. Baumeister4; Henning von
Gregory4; Günter Germann4; Detlev Erdmann1; L. Scott Levin1; (1)Duke University, (2)University of Modena and Reggio Emilia, (3)A.U.O. Careggi, (4)BG Trauma Center
Ludwigshafen/University of Heidelberg
Background:
Free vascularized tissue transfer to preserve upper extremity amputation level is an uncommon procedure, and its overall indications may be controversial. This study investigates
the role of free tissue transfer in preserving both morphology and function of the amputated upper extremity, from the perspective of a prosthetic rehabilitation.
Methods:
Thirteen patients that underwent microsurgical free tissue transfer to preserve upper extremity amputation level were reviewed retrospectively. These cases were
selected from four centers: Duke University Medical Center (Durham, NC, USA) University Hospital of Modena (Modena, Italy), Carreggi University Hospital
(Florence, Italy), University of Heidelberg (Heidelberg, Germany). Parameters that were evaluated included: age, gender, etiology of the defect, reconstructive
procedure, structures to be salvaged, functional outcome and others.
Results:
Etiology of the amputation was trauma in 92% of patients. Mean age was 32 years. Only 30% of the cases were reconstructed with an emergency free fillet
flap, and in the remaining 70%, a traditional free flap was performed. Structures/functions to be preserved included: pinch function to the hand, elbow joint,
shoulder joint, and skeletal length greater than 7 cm. Complications occurred in 38% of the cases, but the final goal of the procedure was achieved in all cases.
A treatment algorithm has been devised.
Conclusions:
Free vascularized tissue transfer to preserve function to an amputated upper extremity represents a valid option in well selected cases.
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