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  • 1
    Online-Ressource
    Online-Ressource
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Plastic and Reconstructive Surgery - Global Open Vol. 10, No. 9 ( 2022-09), p. e4538-
    In: Plastic and Reconstructive Surgery - Global Open, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. 9 ( 2022-09), p. e4538-
    Kurzfassung: Acquired soft-tissue defects of the hand can be a result of different types of trauma, infection, tumor resection, or burns. The evolution of the design and types of flaps have optimized the reconstruction and, nowadays, it is important to achieve not only a functional result but also an aesthetic result. The aim of the present study is to propose a model for treating a wide variety of skin defects in the hands based on our flap experience. Methods: We conducted a retrospective study from February 2019 to January 2022, which included all patients who underwent a skin flap for hand reconstruction. Patients’ medical records were reviewed and data collected included demographics, smoking status, presence of risk factors, type of trauma, flap reconstruction, dimensions, reoperations, and long-term complications. Results: A total of 99 patients underwent skin flap-based reconstruction for hand trauma between February 2019 until January 2022. The mean age was 43.9 (range 38.3–49.5), 87.9% of patients were male, and follow-up was between 2 and 30 months; 90.9% of the flaps were free flaps, and the rest were pedicle flaps (3% of them being propeller flaps). Conclusions: When planning a hand reconstruction, it is vital to ensure that the outcomes are not only functional but also aesthetic, with minimum donor site morbidity; in this study, we showed a variety of flaps that can be applied to achieve this goal. We believe that the final decision should be made after comprehending the defect and the patient’s preferences.
    Materialart: Online-Ressource
    ISSN: 2169-7574
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2022
    ZDB Id: 2723993-7
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
    Online-Ressource
    Online-Ressource
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Plastic and Reconstructive Surgery - Global Open Vol. 10, No. 9 ( 2022-09), p. e4540-
    In: Plastic and Reconstructive Surgery - Global Open, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. 9 ( 2022-09), p. e4540-
    Kurzfassung: Finger amputations are one of the most common traumas of daily life. Regularization of the digital stump is the most widely used option in the literature today. The aim of this study was to evaluate a valid functional and aesthetic alternative to amputation. Methods: We retrospectively investigated our prospective database‚ selecting the patients who underwent trimmed great toe flap reconstruction for the amputation of a digit from September 2019 to November 2021. All the operations were performed by the first author (L.T.) in the Reconstructive Microsurgery Service of the University Department of Hand Surgery and Rehabilitation of MultiMedica Group. Results: No flap required anastomosis revision or had major complications. The length of the amputated finger was maintained, with a high functional and aesthetic result achieved. Conclusions: The trimmed great toe flap has proven to be a viable alternative to finger amputation in the reconstruction of thumb and long finger defects, leading to high aesthetic results. The morbidity of the donor site is reduced compared with the classic great toe flap, allowing a direct closure in most cases.
    Materialart: Online-Ressource
    ISSN: 2169-7574
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2022
    ZDB Id: 2723993-7
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
    Online-Ressource
    Online-Ressource
    Wiley ; 2019
    In:  Clinical Case Reports Vol. 7, No. 12 ( 2019-12), p. 2371-2374
    In: Clinical Case Reports, Wiley, Vol. 7, No. 12 ( 2019-12), p. 2371-2374
    Kurzfassung: The results of this case suggest that the IMAP propeller flap may be a viable and safe option for deep sternal wound reconstruction with minimal donor‐site morbidity.
    Materialart: Online-Ressource
    ISSN: 2050-0904 , 2050-0904
    URL: Issue
    Sprache: Englisch
    Verlag: Wiley
    Publikationsdatum: 2019
    ZDB Id: 2740234-4
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
    Online-Ressource
    Online-Ressource
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Plastic and Reconstructive Surgery - Global Open Vol. 10, No. 1 ( 2022-01), p. e4054-
    In: Plastic and Reconstructive Surgery - Global Open, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. 1 ( 2022-01), p. e4054-
    Kurzfassung: The aim of post-traumatic digital reconstruction is to restore form and function, allowing early rehabilitation. In the absence of feasible local options, free tissue transfer can be a versatile and reliable alternative. The aim of this study was to describe our experience with the use of the free proximal ulnar artery perforator flap (PUPF). Methods: Our prospectively maintained free flap database was inquired for patients that had undergone digital reconstructions with free PUPFs. Results: Six patients that underwent digital reconstruction were eligible. The ipsilateral forearm was donor site of choice, with all flaps based on a perforator of the ulnar artery, without the need to compromise the main vessel. A superficial vein was routinely included with the flap. No flap failures were encountered. Mean hospital stay was 5.5 days, and all patients achieved a satisfactory functional result. Conclusions: The proximal ulnar perforator free flap offers an alternative for finger reconstruction, having the advantage of including thin and hairless skin from the proximal ulnar forearm. The vascular anatomy of the ulnar perforators seems to be constant. Furthermore, donor site morbidity is low, as the ulnar artery is not harvested with the flap, the donor site defect can generally be closed directly, and the scar is well concealed.
    Materialart: Online-Ressource
    ISSN: 2169-7574
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2022
    ZDB Id: 2723993-7
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 5
    Online-Ressource
    Online-Ressource
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Plastic and Reconstructive Surgery - Global Open Vol. 10, No. 9 ( 2022-09), p. e4535-
    In: Plastic and Reconstructive Surgery - Global Open, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. 9 ( 2022-09), p. e4535-
    Kurzfassung: High-quality evidence is currently poor regarding the benefits of end-to-end (ETE) or end-to-side (ETS) anastomosis in arterial and venous anastomoses, despite being postulated as a potential influence on outcomes. A sufficient microvascular anastomosis is indispensable for the success of any free tissue transfer. ETS microvascular anastomoses have been becoming increasingly important as they allow reconstruction even in patients with impaired vascular status. To the authors’ knowledge, no studies have examined the choice of ETE or ETS anastomoses specifically for digital arteries. Methods: We conducted a retrospective study of ETE and ETS anastomosis cases; the only inclusion criteria was that digital arteries (proper, common) were the recipient vessels. Results: Fifty-seven cases met the inclusion criteria. All the venous anastomoses were ETE. Of these cases, four total intraoperative complications (immediate thrombosis) and only one case of complete failure were registered. The ETE group consisted of 49 patients and the ETS group of eight patients. A comparison of the mean ischemia time in the two groups showed no statistically significant difference ( P = 0.121). Conclusions: We observed no difference in the reconstructive outcomes of hand free-flaps and reconstruction between ETE or ETS digital arteries anastomoses. The successful microsurgical reconstruction was independent of anastomotic technique. In particular, the results of our study demonstrated no statistically significant increase of the ischemia time; thus, no prolongation of operative time can be attributed to the higher technical challenge of the anastomosis.
    Materialart: Online-Ressource
    ISSN: 2169-7574
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2022
    ZDB Id: 2723993-7
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
    Online-Ressource
    Online-Ressource
    Georg Thieme Verlag KG ; 2022
    In:  Journal of Hand and Microsurgery Vol. 14, No. 03 ( 2022-07), p. 216-221
    In: Journal of Hand and Microsurgery, Georg Thieme Verlag KG, Vol. 14, No. 03 ( 2022-07), p. 216-221
    Kurzfassung: Introduction The medial gastrocnemius flap is an established workhorse flap to cover proximal leg defects due to its reliability and simplicity to raise. However, it has the disadvantage of being bulky, requiring a skin graft for coverage, and is associated with loss of muscle power. The pedicled medial sural artery perforator (MSAP) flap has gained popularity as a reconstructive alternative for defects of the lower extremities. We present a case series of pedicled MSAP flaps for reconstructing defects around the knee as an alternative to the medial gastrocnemius flap. Materials and Methods A consecutive series of patients with proximal leg defects following trauma, osteomyelitis, burns, and chronic wounds were included. A hand-held Doppler was used to map out the MSAPs. Defects were reconstructed using pedicled MSAP flaps, preserving the nerve supply to the gastrocnemius muscle. Patient outcomes were recorded, including their Enneking scores postreconstruction. Results A total of 10 pedicled flaps was performed to reconstruct defects around the knee joint between October 2017 and November 2018. All the patients were discharged 1 week postoperatively, and rehabilitation consisted of graduated flexion in a knee brace by means of controlled passive mobilization. Three out of the ten patients developed complications: one patient developed flap congestion, one developed epidermolysis of the tip of the flap, and the other patient had partial necrosis of the skin paddle. The average Enneking score was 29 out of 35. Conclusion The pedicled MSAP flap is a good reconstructive option for proximal leg defects as it is associated with lower donor site morbidity and provides an aesthetically pleasing reconstruction.
    Materialart: Online-Ressource
    ISSN: 0974-3227 , 0974-6897
    Sprache: Englisch
    Verlag: Georg Thieme Verlag KG
    Publikationsdatum: 2022
    ZDB Id: 2546232-5
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 7
    Online-Ressource
    Online-Ressource
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Plastic and Reconstructive Surgery - Global Open Vol. 10, No. 9 ( 2022-09), p. e4537-
    In: Plastic and Reconstructive Surgery - Global Open, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. 9 ( 2022-09), p. e4537-
    Kurzfassung: The use of the radial artery (RA) as a recipient vessel in the hand is mainly described in the snuffbox. However, we believe that employing the RA distally to the extensor pollicis longus (EPL) tendon may provide remarkable advantages. Methods: We conducted a prospective study from June 2019 until December 2021, which included all patients who underwent reconstructive procedures with the RA distally to the snuffbox as the recipient vessel. We reviewed patients’ medical records: demographics, type of trauma, defect characteristics, microsurgical procedure, reoperations, and short- and long-term complications. Results: We found 23 patients eligible for this study; 22 patients required a reconstructive procedure due to a trauma and one for a congenital malformation. RA distal to snuffbox was always identified and judged reliable and apt as a recipient vessel. There were no issues with the anastomosis and no total flap failure in all cases. The morbidity in the recipient area was also minimal, with no mobility deficits, loss of sensation, or neuroma development. Conclusions: The RA is the primary vessel in the dorsum of the distal upper limb; performing the anastomosis distally to the EPL tendon may offer various advantages, making the surgery safer and less invasive.
    Materialart: Online-Ressource
    ISSN: 2169-7574
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2022
    ZDB Id: 2723993-7
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 8
    Online-Ressource
    Online-Ressource
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Plastic and Reconstructive Surgery - Global Open Vol. 10, No. 9 ( 2022-09), p. e4539-
    In: Plastic and Reconstructive Surgery - Global Open, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. 9 ( 2022-09), p. e4539-
    Kurzfassung: Since its inception, the great toe pulp (GTP) flap has represented a valid therapeutic choice in the reconstruction of defects of the hand. This study illustrates the clinical outcomes of GTP free flaps performed without nerve anastomosis‚ mainly for fingertip defect reconstruction. Methods: We performed a retrospective, monocentric cohort study. All patients included in this study presented with fingertip traumatic injury, with tendon or bone exposure; reconstruction with GTP flap, without nerve reconstruction, was performed by the first author (L.T.) from May 2019 to October 2021. Results: All 37 flaps survived completely. Due to COVID restrictions‚ we had to send the tests and PROMs to our patients; 28 of them replied. Cold intolerance was reported by 12 patients (moderate in two cases and mild in ten cases). No pain was complained about either in hand or donor site (Visual Analog Score 0, at rest and at movement). Complete range of motion was achieved in 22 of 28 patients. All flaps recovered protective sensitivity. In every section of the Michigan Hand Outcome Questionnaire, all patients expressed a high level of satisfaction based on the reconstruction’s function and aesthetics. Regarding the donor site morbidity, no patient complained about gait disturbance. Conclusions: This study showed that the GTP flap is the optimal choice for fingertip reconstruction, providing excellent functional and aesthetic results with durable and glabrous skin, satisfactory pulp contour, and sensory restoration. These results could be achieved with no need for nerve suture, especially in defects with no injuries proximal to the loss of substance.
    Materialart: Online-Ressource
    ISSN: 2169-7574
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2022
    ZDB Id: 2723993-7
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 9
    Online-Ressource
    Online-Ressource
    Elsevier BV ; 2022
    In:  Journal of Hand and Microsurgery Vol. 14, No. 1 ( 2022), p. 96-99
    In: Journal of Hand and Microsurgery, Elsevier BV, Vol. 14, No. 1 ( 2022), p. 96-99
    Materialart: Online-Ressource
    ISSN: 0974-3227
    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 2022
    ZDB Id: 2546232-5
    Standort Signatur Einschränkungen Verfügbarkeit
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