Floor plan - 2013 Annual Meeting - American Association for Hand ...

The Use of Free Medial Pedis Perforator Flap in The Treatment of Chron˘c Postburn Palmar
Contractures
Institution where the work was prepared: GATA Haydarpa?a E?itim Hastanesi dept. of Plastic Surgery, ?stanbul, Turkey
Haluk Duman, Assoc, Prof, MD; Fatih Uygur; Ersin ülkür; Sinan öksüz; Bahattin çeliköz; GATA Haydarpa?a E?itim hastanesi
INTRODUCTION:
Hand burns are quite important since functional recovery is an obligation. However, inadequate treatment at the very beginning causes
severe functional deficiencies which can be difficult to correct. The unique anatomic characteristics of the hand which are thick, sensate
and glabrous skin provide a cushioning and durability effect. In the present study, we introduce the free medialis pedis perforator
flap in the coverage of palmar defects resulting from radical release of chronic postburn contractures.
METHOD:
Eight patients with palmar contractures were treated with free medialis pedis perforator flap between May 2005 and November 2007.
The flaps were planned on the medial aspect of the foot and elevated as fasciocutaneous perforator flap. The flap sizes ranging from
1.5 x 3.0 cm to 3.0 x 6.5 cm. The flaps were transferred to the palmar defects resulting from radical release of chronic postburn contractures.
Arterial anastomosis were performed with flap artery and proper digital arteries in all but two cases. Venous anastomosis was
done between superficial vein which included in the flap and the recipient superficial vein.The flap donor sites were closed with splitthickness
skin graft in all patients. The mean follow-up period was 10,5 months.
RESULTS:
The transplanted flaps survived with satisfactory recovery in function. Grasp function of the hand was dramatically improved. Deep sensation
appeared by the end of the second month, and superficial sensation returned in all cases, as assessed by monofilament testing
(Semmes-Weinstein). In two cases transient venous insufficiency was encountered and resolved with elevation.
CONCLUSION:
We believe that the medialis pedis flaps were a remarkable alternative for palmar reconstruction of the hand and digits due to burn
because of its glabrous skin, which is very similar to palmar skin and with low donor site morbidity. Although the main disadvantage of
this flap is non sansate, protective sensation was regained in all cases.
The Effect of Preoperative Radiotherapy on the Free Jejunum Flap Transfer
Institution where the work was prepared: E-Da Hospital, Kao-hsiung, Taiwan
Hung-Chi Chen, MD, FACS1; Yueh-Bih Tang, MD, PhD2; Samir Mardini, MD1; Christopher Salgado1; Chung-chen Hsu,
MD3; (1)E-da/I-I Shou University Hospital, (2)National Taiwan University Hospital, (3)Chang Gung Memorial Hospital
BACKGROUND:
Microvascular free jejunum flap transfer has been widely employed for reconstruction of defects following ablation of malignant tumors
in the pharynx and larynx. Preoperative radiation therapy has two effects: (1) tissue fibrosis in the neck, which may interfere with wound
healing, and (2) damage to vascular intima which induced a higher rate of thrombosis after microvascular anastomoses in the animal
studies. However, in the clinical situation it is still not clear whether preoperative irradiation causes more complications including survival
of the flap.
PATIENTS AND METHODS:
From 1998 to 2006, 67 patients with cancers in the pharynx and larynx had been reconstructed with free jejunum flap transfer after wide
excision. Among them 31 cases had preoperative radiation (group I )and 36 (group II) did not have radiation. A retrospective study was
performed with a focus on survival, re-exploration and other complications including leakage, dysphagia and later stricture.
RESULTS:
Reexploration was performed in 2 patients in group I and 3 patients in group II. Among them all flaps were salvaged except for one
patient in group II. The other complications were found in 20 % of patients in group I and 22 % in group II. There was no statistically significant
difference in the two groups.
CONCLUSION:
Theoretically, preoperative radiation therapy should pose more problems in microsurgical reconstruction. In this series it did not affect
the results of free jejunum flap transfer. Technical pearls in dealing with this difficult situation are presented.
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