J Hand Microsurg 2009; 01(01): 25-31
DOI: 10.1007/s12593-009-0007-6
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

The place of local/regional perforator flaps in complex traumas of the forearm

Alexandru V. Georgescu
1   University of Medicine ‘Iuliu Hatieganu’ Recovery Clinic Hospital Clinic of Plastic Surgery and Reconstructive Microsurgery, Cluj-Napoca, Romania   Email: geordv@hotmail.com
,
I. Capota
1   University of Medicine ‘Iuliu Hatieganu’ Recovery Clinic Hospital Clinic of Plastic Surgery and Reconstructive Microsurgery, Cluj-Napoca, Romania   Email: geordv@hotmail.com
,
I. Matei
,
F. Ardelean
1   University of Medicine ‘Iuliu Hatieganu’ Recovery Clinic Hospital Clinic of Plastic Surgery and Reconstructive Microsurgery, Cluj-Napoca, Romania   Email: geordv@hotmail.com
,
A. Avram
1   University of Medicine ‘Iuliu Hatieganu’ Recovery Clinic Hospital Clinic of Plastic Surgery and Reconstructive Microsurgery, Cluj-Napoca, Romania   Email: geordv@hotmail.com
,
I. Ignatiadis
2   KAT Hospital, Athens, Greece
,
O. Olariu
1   University of Medicine ‘Iuliu Hatieganu’ Recovery Clinic Hospital Clinic of Plastic Surgery and Reconstructive Microsurgery, Cluj-Napoca, Romania   Email: geordv@hotmail.com
› Author Affiliations

Subject Editor:
Further Information

Publication History

12 February 2009

14 March 2009

Publication Date:
02 September 2016 (online)

Abstract

Background

Our aim was to conduct a retrospective study regarding the advantages of doing the all-in-one reconstruction in the same step with the debridement, and the possibility of using the local/regional perforator flaps to cover the tissue defects.

Methods

We reviewed a series of 137 cases from 1999 until now, for acute traumas with tissue defects of the forearm. We performed a regional perforator flap in 16 cases, and a local perforator flap in 121 cases. These flaps were used for both simple and complex defects coverage, including 26 cases with fractures and devascularization.

Results

The follow-up was between 2 months and 2 years. In all the cases the extremity was salvaged and an useful functional recovery was obtained. A very good evolution, with complete survival of the flap was recorded in 133 cases. We completely lost only one flap, and registered minor complications in three cases.

Conclusion

The local perforator flaps represent a good and safe indication for small and medium defects in the forearm.

 
  • References

  • 1 Brown PW. Open injuries of the hand. In: Green DP. Green’s Operative Hand Surgery. 4th edn New York: Churchill Livingstone; 1999. pp 1607-1630
  • 2 Shieh SJ, Lee JW, Chiu HY. Long-term functional results of primary reconstruction of severe forearm injuries. J Plast Reconstr Aesthet Surg 2006; 60: 339-348
  • 3 Lister G. Emergency free flaps. In: Green DP. Operative Hand Surgery. 2nd edn New York: Churchill Livingstone; pp 1127-1149
  • 4 Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 1986; 78: 285-292
  • 5 Lister G, Scheker L. Emergency free flaps to the upper extremity. J Hand Surg [Am] 1998; 13: 22-28
  • 6 Auclair E, Guelmi K, Selinger R et al Emergency use of free transfers for treatment of upper limb complex traumas. About 18 cases. Ann Chir Plast Esthet 1994; 39: 338-345
  • 7 Sauerbier M, Erdmann D, Bickert B et al Reconstruction of defects of the forearm and hand with the combined scapular-parascapular free flap. Handchir Mikrochir Plast Chir 2001; 33: 20-25
  • 8 Georgescu AV, Ivan O. Emergency free flaps. Microsurg 2003; 23: 206-216
  • 9 Tran Quan J, Hu W, Le Nen D, et al. Compound tissue reconstruction of the forearm in emergency. About 17 clinical cases. Ann Chir Plast Esthet 2006; 51: 187-194
  • 10 Kremer T, Bickert B, Germann G, et al. Outcome assessment after reconstruction of complex defects of the forearm and hand with osteocutaneous free flaps. Handchir Mikrochir Plast Chir 2007; 39: 388-395
  • 11 Wang D, Levin LS. Composite tissue transfer in upper extremity trauma. Injury 2008; 39S: S90-S96
  • 12 Parteke BE, Buck-Gramcko D. Free forearm flap for reconstruction of soft tissue defects concurrent with improved peripheral circulation. J Reconstr Microsurg 1984; 1: 1-8
  • 13 Brandt K, Khouri RK, Upton J. Free flaps as flowthrough vascular conduits for simultaneous coverage and revascularization of the hand or digits. Plast Reconstr Surg 1999; 2: 321-326
  • 14 Georgescu AV, Ivan O, Oancea A et al The concept of “flow-through flap”: its contribution in solving complex trauma of the upper limb. In: Venkataswami R, Balakrish-nan G, (eds) Scientific transactions of the Combined Congress of the Asian Pacific Federations of Societies for Surgery of the Hand, Indian Society for Surgery of the Hand and Indian Society for Reconstructive Microsurgery. Chennai, India: 11–15 August
  • 15 Kesiktas E, Yavuz M, Dalay C et al Upper extremity salvage with a flow-through free flap. Ann Plast Surg 2007; 58: 630-635
  • 16 Gedebou TM, Wei FC, Lin CH. Clinical experience of 1284 free anterolateral thigh flaps. Handchir Mikrochir Plast Chir 2002; 34: 239-244
  • 17 Schwabegger AH, Bonder G, Ninkovic M et al Thoracodorsal artery perforator (TAP) flap: report of our experience and review of the literature. Br J Plast Surg 2002; 55: 390-395
  • 18 Deiler S, Pfadenhauer A, Widmann J et al Tensor fasciae latae perforator flap for reconstruction of composite Achilles tendon defects with skin and vascularised fascia. Plast Reconstr Surg 2000; 106: 342-349
  • 19 Cavades PC, Sanz-Gimenez-Rico JR, Gutierez-de la Camara A et al The medial sural artery perforator free flap. Plast Reconstr Surg 2001; 108: 1609-1615
  • 20 Hallock GG. Further experience with the medial circumflex femoral GRACILIS perforator flap. J Reconstr Microsurg 2004; 20: 115-122
  • 21 Blondeel Ph N, Van Landuyt KHI, Monstrey SJM et al The ‘Gent’ consensus of perforator flap terminology: preliminary definitions. Plast Reconstr Surg 2003; 112: 1378-1382
  • 22 Georgescu AV, Ivan O. Lambeau radial antebrachial en ilot base sur des perforantes distales. A propos d’un cas clinique. Ann Chir Plast Esthet 2000; 45: 58-61
  • 23 Fujiwara M, Kawakatsu M, Yoshida Y et al Modified posterior interosseous flap in hand reconstruction. Tech Hand Up Extrem Surg 2003; 7: 102-109
  • 24 Akn S. V-Y advancement island flap based on the perforator of the anterior interosseous artery. Ann Plast Surg 2003; 51: 51-56
  • 25 Giunta R, Geisweid A, Lukas B et al Perforator flap plasty and applications to hand surgery. Handchir Mikrochir Plast Chir 2000; 32: 399-403
  • 26 Georgescu A, Matei I, Ardelean F, Capota I. Microsurgical nonmicrovascular flaps in forearm and hand reconstruction. Microsurg 2007; 27: 384-394
  • 27 Kim KS. Distally based dorsal forearm fasciosubcutaneous flap. Plast Reconstr Surg 2004; 114: 389-396
  • 28 Chang S-M, Hou C-L, Zhang F et al Distally based radial forearm flap with preservation of the radial artery: anatomic, experimental, and clinical studies. Microsurg 2003; 23: 328-337
  • 29 Weinzweig N, Chen L, Chen Z-W. The distally based radial forearm fasciosubcutaneous flap with preservation of the radial artery: an anatomic and clinical approach. Plast Reconstr Surg 1994; 94: 675-68
  • 30 Koshima I, Moriguchi T, Etoh H et al The radial artery perforator based adipofascial flap for dorsal hand coverage. Ann Plast Surg 1995; 35: 474-479
  • 31 Hamdy EK, Zeidan M. Island adipofascial flap based on distal perforators of the radial artery: an anatomic and clinical investigation. Plast Reconstr Surg 1997; 100: 1762-1766
  • 32 Jeng SF, Wei FC. The distally based forearm island flap in hand reconstruction. Plast Reconstr Surg 1998; 102: 400-440
  • 33 Tzeng YS, Yu CC, Dai NT et al The abdominohypogastric flap as a salvage flap for composite wound coverage of the forearm and elbow. J Med Sci 2007; 27: 185-188
  • 34 Hsieh CH, Kuo YR, Yao SF et al Primary closure of radial forearm flap donor defects with a bilobed flap based on fasciocutaneous perforator of the ulnar artery. Plast Reconstr Surg 2004; 113: 1355-1360
  • 35 Lamberty BGH, Cormack GC. The antecubital fasciocutaneous flap. Br J Plast Surg 1983; 36: 428-433
  • 36 Taylor GJ. Discussion: the ‘Gent’ consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg 2003; 112: 1384-1387
  • 37 Timmons MJ. The vascular basis of the radial forearm flap. Plast Reconstr Surg 1986; 77: 80-89
  • 38 Gumener R, Montandon D. Distally based forearm fasciosubcutaneous flap. Plast Reconstr Surg 2004; 114: 397-399
  • 39 Lamberty BGH, Cormack GC. The forearm angio-tomes. Br J Plast Surg 1982; 35: 420-429
  • 40 Inoue Y, Taylor GI. The angiosomes of the forearm: anatomic study and clinical implications. Plast Reconstr Surg 1996; 98: 195-210
  • 41 Taylor GI, Doyle M, McCarten G. The Doppler probe for planning flaps: anatomical study and clinical applications. Br J Plast Surg 1990; 43: 1-16
  • 42 Blondeel PN, Beyens G, Verhaeghe R et al Doppler flowmetry in the planning of perforator flaps. Br J Plast Surg 1998; 51: 202-209
  • 43 Ahn CY, Narayanan K, Shaw WW. In vivo anatomic study of cutaneous perforators in free flaps using magnetic resonance imaging. J Reconstr Microsurg 1994; 10: 157-163
  • 44 Zetterman E, Salmi A, Suominen S et al Effect of cooling and warming on thermographic imaging of the perforating vessels of the abdomen. Eur J Plast Surg 1999; 22: 58-61
  • 45 Rand RP, Cramer MM, Strandness Jr DE. Color-flow duplex scanning in the preoperative assessment of TRAM flap perforators: a raport of 32 consecutive patients. Plast Reconstr Surg 1994; 93: 453-459
  • 46 Komuro Y, Iwata H, Inoue M et al Versatility of scanning laser Doppler imaging to detect cutaneous perforators. Ann Plast Surg 2002; 48: 613-616