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J Reconstr Microsurg 2009; 25(4): 233-236
DOI: 10.1055/s-0028-1104552
© Thieme Medical Publishers

Functional and Aesthetic Outcome of a Complex Upper-Limb Reconstruction after Criminal Caustic Injection

Calin Constantin Lazar1 , M. Revol2 , J-M. Servant2
  • 1Department of Plastic and Reconstructive Surgery, René Dubos Hospital, Pontoise, France
  • 2Department of Plastic, Reconstructive and Aesthetic Surgery, Saint Louis University Hospital, Paris, France
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Publication History

Publication Date:
05 December 2008 (online)

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ABSTRACT

Extensive upper-limb injuries are usually secondary to accidental partial or complete avulsions or massive burns. Caustic injections are an exceptional etiology, with terrible lesions that present therapeutic challenges and major aftereffects. We report the case of a 41-year-old patient presenting with a large and deep anterior necrosis of the upper-limb anterior tissues, after a criminal intravenous injection of caustic soda on the inner side of his left elbow. Reconstruction methods consisted of a homolateral latissimus dorsi pediculated flap, a humeroulnar vascular bypass, a medial nerve autograft, and a secondary palliative Brand 1 procedure. Final functional and aesthetic results, obtained after long-term physiotherapy, were unexpectedly good. In conclusion, reconstructive surgery of such major lesions cannot be considered without a multidisciplinary approach. Moreover, patients have to be well informed about the necessity of multiple surgical interventions, the risk of major handicap, and the unpredictable nature of the final outcome.

KEYWORDS

Caustic - latissimus dorsi flap - microneurovascular surgery - necrosis - upper limb

REFERENCES

  • 1 Schoeller T, Wechselberger G, Hussl H, Huemer G M. Functional transposition of the latissimus dorsi muscle for biceps reconstruction after upper arm replantation.  J Plast Reconstr Aesthet Surg. 2007;  60(7) 755-759
    CrossrefPubMedSearch in Google Scholar
  • 2 Chai J, Song H, Sheng Z, Chen B, Yang H, Li L. Repair and reconstruction of massively damaged burn wounds.  Burns. 2003;  29(7) 726-732
    CrossrefPubMedSearch in Google Scholar
  • 3 Téot L, Griffe O, Brabet M, Gartner R. Chemical burns of the hand and upper limb: therapeutic approach.  Ann Chir Main Memb Super. 1992;  11(2) 132-140
    PubMedSearch in Google Scholar
  • 4 Wang N, Shen Z, Mi H. One stage repair and reconstruction for severe deep burns with compound tissue defects of upper limb.  Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 1998;  12(1) 23-25
    PubMedSearch in Google Scholar
  • 5 Blin F, Rochette J, Taulet G, Pellerin M, Marsepoil T, Starkman M. Voluntary poisoning by intravenous injection of caustic soda.  Ann Fr Anesth Reanim. 1983;  2(2) 97-99
    PubMedSearch in Google Scholar
  • 6 Okumura T, Suzuki K, Yamane K et al.. Intravenous detergent poisoning.  J Toxicol Clin Toxicol. 2000;  38(3) 347-350
    CrossrefPubMedSearch in Google Scholar
  • 7 Bikhazi H B, Thompson E R, Shumrick D A. Caustic ingestion: current status. A report of 105 cases.  Arch Otolaryngol. 1969;  89(5) 770-773
    PubMedSearch in Google Scholar
  • 8 Mialaret J. Pyloric stenosis due to ingestion of a caustic.  Mem Acad Chir (Paris). 1950;  76(10–11) 354
    PubMedSearch in Google Scholar
  • 9 Piaget F, Michel F. Severe pyloric lesions caused by caustic ingestion.  J Fr Otorhinolaryngol Chir Maxillofac. 1965;  14(6) 593-596
    PubMedSearch in Google Scholar
  • 10 Dagum A B, Slesarenko Y, Winston L, Tottenham V. Long-term outcome of replantation of proximal-third amputated arm: a worthwhile endeavor.  Tech Hand Up Extrem Surg. 2007;  11(4) 231-235
    CrossrefPubMedSearch in Google Scholar
  • 11 Maladry D, Fechant C, Guelmi K, Mitz V, Lemerle J P. Severe injuries of the elbow: emergency coverage and transient revascularization. Apropos of 13 cases over a 3-year period.  Ann Chir Plast Esthet. 1994;  39(3) 362-371
    PubMedSearch in Google Scholar
  • 12 Hamdi M, Van Landuyt K, Monstrey S, Blondeel P. A clinical experience with perforator flaps in the coverage of extensive defects of the upper extremity.  Plast Reconstr Surg. 2004;  113(4) 1175-1183
    CrossrefPubMedSearch in Google Scholar
  • 13 Yunchuan P, Jiaqin X, Sihuan C, Zunhong L. Use of the lateral intercostal perforator-based pedicled abdominal flap for upper-limb wounds from severe electrical injury.  Ann Plast Surg. 2006;  56(2) 116-121
    CrossrefPubMedSearch in Google Scholar
  • 14 Axer A, Segal D, Elkon A. Partial transposition of the latissimus dorsi. A new operative technique to restore elbow and finger flexion.  J Bone Joint Surg [Am]. 1973;  55(6) 1259-1264
    PubMedSearch in Google Scholar
  • 15 Mi H, Shen Z, Wang N. Restoration of elbow joint and its function by transposition of latissimus dorsi myocutaneous flap following serious high-voltage injury in upper limb.  Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi. 1998;  14(6) 433-435
    PubMedSearch in Google Scholar
  • 16 Mordick II T G, Britton E N, Brantigan C. Pedicled latissimus dorsi transfer for immediate soft-tissue coverage and elbow flexion.  Plast Reconstr Surg. 1997;  99(6) 1742-1744
    CrossrefPubMedSearch in Google Scholar
  • 17 Zhu S X, Lu S B, Zhang B X, Wang J F, Yao J X, Kong X X. Reconstruction of finger flexion function with latissimus dorsi myocutaneous free flap and microneurovascular surgery.  Chin Med J (Engl). 1982;  95(10) 731-736
    PubMedSearch in Google Scholar

Calin Constantin LazarM.D. 

Department of Plastic and Reconstructive Surgery, René Dubos Hospital

95303 Pontoise, France

Email: lazarcalin@yahoo.fr