Download PDF
CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2021; 06(01): e51-e56
DOI: 10.1055/s-0041-1729954
Case Report

Epimysial Transposition Flap: A Novel Technique for Coverage of Exposed Tendon after Tissue Transfer

Nicholas F. Lombana
1   Division of Plastic and Reconstructive Surgery, Baylor-Scott and White, Temple, Texas
,
Reuben A. Falola
1   Division of Plastic and Reconstructive Surgery, Baylor-Scott and White, Temple, Texas
,
Michael Scott
1   Division of Plastic and Reconstructive Surgery, Baylor-Scott and White, Temple, Texas
,
Michel H. Saint-Cyr
1   Division of Plastic and Reconstructive Surgery, Baylor-Scott and White, Temple, Texas
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background The radial forearm flap (RFF) is a versatile flap that can be used for soft-tissue coverage or as a source of vascularized bone during reconstruction. A problem that can arise after RFF harvest is tendon exposure in the donor site, which may lead to tendon injury and restriction of the hand and wrist’s range of motion. Many different methods for providing adequate tendon coverage in the donor site after RFF harvest have been reported. We present a novel technique for coverage of exposed tendon in the volar forearm with an epimysial transposition flap and a split-thickness skin graft (STSG).

Methods Retrospective review of two cases: one salvage case with exposed tendon after harvesting an RFF and another with exposed volar forearm tendon after traumatic injuries. Variables of interest were post-operative STSG integration and hand/wrist range of motion.

Results Both cases demonstrated 100% graft take at 5-week follow-up. No decrease in hand/wrist range of motion in the patient that could undergo testing.

Conclusion We introduce two cases for coverage of exposed flexor tendon in the volar forearm with an epimysial transposition flap. This can be used as a salvage operation for coverage of exposed tendon or as an acute method of tendon coverage prior to skin grafting. In both cases, the skin graft had excellent incorporation.

Keywords

radial forearm flap - epimysial transposition flap - upper extremity reconstruction


Publication History

Received: 17 July 2020

Accepted: 27 January 2021

Article published online:
29 June 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Simman R, Hermans MHE. Managing wounds with exposed bone and tendon with an esterified hyaluronic acid matrix (eHAM): a literature review and personal experience. J Am Coll Clin Wound Spec 2018; 9 (1–3): 1-9
    PubMedSearch in Google Scholar
  • 2 Trumble TE. Principles of Hand Surgery and Therapy. Philadelphia, PA: W.B. Saunders; 2000
    Search in Google Scholar
  • 3 Pabst AM, Werkmeister R, Steegmann J, Hölzle F, Bartella A. Is there an ideal way to close the donor site of radial forearm free flaps?. Br J Oral Maxillofac Surg 2018; 56 (06) 444-452
    CrossrefPubMedSearch in Google Scholar
  • 4 Nehrer-Tairych GV, Millesi W, Schuhfried O, Rath T. A comparison of the donor-site morbidity after using the prelaminated fasciomucosal flap and the fasciocutaneous radial forearm flap for intraoral reconstruction. Br J Plast Surg 2002; 55 (03) 198-202
    CrossrefPubMedSearch in Google Scholar
  • 5 Bucholz RW, Heckman JD, Court-Brown CM, Rockwood CA, Green DP. eds. Rockwood and Green's Fractures in Adults. Vol. 1. Philadelphia, PA: Lippincott, Williams & Wilkins; 2006
    Search in Google Scholar
  • 6 Davis-Zeek D. Pearls for practice: managing wounds with exposed tendon. Wound Management and Prevention 2009;55(10):
    PubMed
  • 7 Etzkorn JR, Sobanko JF, Shin TM, Miller CJ. Repair of a large dorsal hand defect with exposed tendons. Dermatol Surg 2018; 44 (12) 1583-1586
    CrossrefPubMedSearch in Google Scholar
  • 8 Skoner JM, Bascom DA, Cohen JI, Andersen PE, Wax MK. Short-term functional donor site morbidity after radial forearm fasciocutaneous free flap harvest. Laryngoscope 2003; 113 (12) 2091-2094
    CrossrefPubMedSearch in Google Scholar
  • 9 Jaquet Y, Enepekides DJ, Torgerson C, Higgins KM. Radial forearm free flap donor site morbidity: ulnar-based transposition flap vs split-thickness skin graft. Arch Otolaryngol Head Neck Surg 2012; 138 (01) 38-43
    CrossrefPubMedSearch in Google Scholar