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Thinned chimeric radial collateral artery perforator flap in complex distal thumb reconstruction

  • Handsurgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Tissue loss accompanied by bone defects in the thumb is a challenging reconstruction problem. Traditional repair methods are unsatisfactory.

Methods

Microsurgical thumb reconstruction was performed using 13 thinned chimeric radial collateral artery (RCA) perforator flaps. The flap was created with a thinned skin paddle and humeral bone segments using independent perforators. Primary defatting was completed when the thickness of the perforator entry was approximately similar to that in the periphery. The posterior cutaneous nerve of the arm was carried to make a sensory flap. Defects were 8.5 × 4.5 cm2 on average (ranging in size from 4.5 × 1.5 to 15.0 × 6.0 cm2), and flap size was 9.0 × 5.5 cm2 on average (ranging in size from 5.0 × 2.0 to 16.0 × 7.0 cm2), whereas the humeral fragments were 2.0 × 1.0 cm2 on average (ranging in size from 1.5 × 0.5 to 4.0 × 1.5 cm2). All data were expressed as mean ± SD. The cosmetic appearance of the donor and recipient sites, Kapandji opposition score and static two-point discrimination of the operated thumb were evaluated during a follow-up visit.

Results

Follow-up time was 16.6 months (ranging from 14 to 28 months). Flap thickness before defatting, measured immediately after flap elevation was 14.5 mm (ranging from 10.0 to 25.0 mm). Average flap thickness after defatting was 3.5 mm (ranging from 3.0 to 6.0 mm). Venous congestion occurred in two cases. Successful microsurgical revision was achieved in both cases. All flaps survived. Bone components achieved union in all cases at an average period of 4.8 months (ranging from 3 to 6 months). Based on Kapandji opposition score, the mean thumb opposition score was 6. The mean sensation of flap was 7.5 mm (ranging from 6 to 11 mm). No further flap revision or defatting procedures were required in all cases. Cosmetically acceptable results were achieved for all patients.

Conclusions

Findings proved that thinned chimeric RCA perforator flap is a beneficial microsurgical alternative for reconstructing complex bone and soft tissue defects in thumb.

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References

  1. Akin S, Ozgenel Y, Ozcan M (2002) Osteocutaneous posterior interosseous flap for reconstruction of the metacarpal bone and soft-tissue defects in the hand. Plast Reconstr Surg 109(3):982–987

    Article  PubMed  Google Scholar 

  2. Arnez ZM, Kersnic M, Smith RW, Godina M (1991) Free lateral arm osteocutaneous neurosensory flap for thumb reconstruction. J Hand Surg Br 16(4):395–399

    Article  CAS  PubMed  Google Scholar 

  3. Buncke HJ Jr, Buncke CM, Schulz WP (1966) Immediate Nicoladoni procedure in the Rhesus monkey, or hallux-to-hand transplantation, utilising microminiature vascular anastomoses. Br J Plast Surg 19(4):332–337

    Article  PubMed  Google Scholar 

  4. Chen C, Tang P, Zhang L, Li X, Zheng Y (2013) Repair of multiple finger defects using the dorsal homodigital island flaps. Injury 44(11):1582–1588

    Article  CAS  PubMed  Google Scholar 

  5. Chen HC, el-Gammal TA (1997) The lateral arm fascial free flap for resurfacing of the hand and fingers. Plast Reconstr Surg 99(2):454–459

    Article  CAS  PubMed  Google Scholar 

  6. Cheng MH, Saint-Cyr M, Ali RS, Chang KP, Hao SP, Wei FC (2009) Osteomyocutaneous peroneal artery-based combined flap for reconstruction of composite and en bloc mandibular defects. Head Neck 31(3):361–370

    Article  PubMed  Google Scholar 

  7. Cobbett JR (1969) Free digital transfer. Report of a case of transfer of a great toe to replace an amputated thumb. J Bone Joint Surg Br 51(4):677–679

    CAS  PubMed  Google Scholar 

  8. Dabernig J, Sorensen K, Shaw-Dunn J, Hart AM (2007) The thin circumflex scapular artery perforator flap. J Plast Reconstr Aesthet Surg 60(10):1082–1096

    Article  CAS  PubMed  Google Scholar 

  9. Daya M (2008) Peroneal artery perforator chimeric flap: changing the perspective in free fibula flap use in complex oromandibular reconstruction. J Reconstr Microsurg 24(6):413–418

    Article  PubMed  Google Scholar 

  10. del Pinal F (2004) The indications for toe transfer after “minor” finger injuries. J Hand Surg Br 29(2):120–129

    Article  PubMed  Google Scholar 

  11. del Pinal F, Garcia-Bernal FJ, Studer A, Ayala H, Cagigal L, Regalado J (2008) Super-thinned iliac flap for major defects on the elbow and wrist flexion creases. J Hand Surg Am 33(10):1899–1904

    Article  PubMed  Google Scholar 

  12. Haas F, Rappl T, Koch H, Pittler P, Scharnagl E (2003) Free osteocutaneous lateral arm flap: anatomy and clinical applications. Microsurgery 23(2):87–95

    Article  PubMed  Google Scholar 

  13. Hallock GG (1991) Simultaneous transposition of anterior thigh muscle and fascia flaps: an introduction to the chimera flap principle. Ann Plast Surg 27(2):126–131

    Article  CAS  PubMed  Google Scholar 

  14. Hallock GG (2008) Chimeric gastrocnemius muscle and sural artery perforator local flap. Ann Plast Surg 61(3):306–309

    Article  CAS  PubMed  Google Scholar 

  15. Hennerbichler A, Etzer C, Gruber S, Brenner E, Papp C, Gaber O (2003) Lateral arm flap: analysis of its anatomy and modification using a vascularized fragment of the distal humerus. Clin Anat 16(3):204–214

    Article  CAS  PubMed  Google Scholar 

  16. Huang WC, Chen HC, Jain V et al (2002) Reconstruction of through-and-through cheek defects involving the oral commissure, using chimeric flaps from the thigh lateral femoral circumflex system. Plast Reconstr Surg 109(2):433–441 (discussion 442–433)

  17. Huang WC, Chen HC, Wei FC, Cheng MH, Schnur DP (2003) Chimeric flap in clinical use. Clin Plast Surg 30(3):457–467

    Article  CAS  PubMed  Google Scholar 

  18. Ignatiadis IA, Mavrogenis AF, Avram AM et al (2008) Treatment of complex hand trauma using the distal ulnar and radial artery perforator-based flaps. Injury 39(Suppl 3):S116–S124

    Article  PubMed  Google Scholar 

  19. Iorio ML, Masden DL, Higgins JP (2011) The limits of medial femoral condyle corticoperiosteal flaps. J Hand Surg Am 36(10):1592–1596

    Article  PubMed  Google Scholar 

  20. Jones NF, Jarrahy R, Kaufman MR (2008) Pedicled and free radial forearm flaps for reconstruction of the elbow, wrist, and hand. Plast Reconstr Surg 121(3):887–898

    Article  CAS  PubMed  Google Scholar 

  21. Katsaros J, Schusterman M, Beppu M, Banis JC Jr, Acland RD (1984) The lateral upper arm flap: anatomy and clinical applications. Ann Plast Surg 12(6):489–500

    Article  CAS  PubMed  Google Scholar 

  22. Katsaros J, Tan E, Zoltie N, Barton M, Venugopalsrinivasan Venkataramakrishnan (1991) Further experience with the lateral arm free flap. Plast Reconstr Surg 87(5):902–910

    Article  CAS  PubMed  Google Scholar 

  23. Kim PD, Blackwell KE (2007) Latissimus-serratus-rib free flap for oromandibular and maxillary reconstruction. Arch Otolaryngol Head Neck Surg 133(8):791–795

    Article  PubMed  Google Scholar 

  24. Kimura N (2002) A microdissected thin tensor fasciae latae perforator flap. Plast Reconstr Surg 109(1):69–77 (discussion 78–80)

  25. Kimura N, Satoh K, Hasumi T, Ostuka T (2001) Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients. Plast Reconstr Surg 108(5):1197–1208 (discussion 1209–1110)

  26. Koshima I, Inagawa K, Urushibara K, Okumoto K, Moriguchi T (2000) Fingertip reconstructions using partial-toe transfers. Plast Reconstr Surg 105(5):1666–1674

    Article  CAS  PubMed  Google Scholar 

  27. Koshima I, Moriguchi T, Fukuda H, Yoshikawa Y, Soeda S (1991) Free, thinned, paraumbilical perforator-based flaps. J Reconstr Microsurg 7(4):313–316

    Article  CAS  PubMed  Google Scholar 

  28. Koshima I, Yamamoto T, Narushima M, Mihara M, Iida T (2010) Perforator flaps and supermicrosurgery. Clin Plast Surg 37(4):683–689, vii–iii

  29. Kremer T, Bickert B, Germann G, Heitmann C, Sauerbier M (2006) Outcome assessment after reconstruction of complex defects of the forearm and hand with osteocutaneous free flaps. Plast Reconstr Surg 118(2):443–454 (discussion 455–446)

  30. Lanzetta M, Bernier M, Chollet A, St-Laurent JY (1997) The lateral forearm flap: an anatomic study. Plast Reconstr Surg 99(2):460–464

    Article  CAS  PubMed  Google Scholar 

  31. Liu J, Song D, Wu S et al (2015) Modified chimeric radial collateral artery perforator flap for repairing hand composite defects. J Reconstr Microsurg 31(3):171–178

    PubMed  Google Scholar 

  32. Moffett TR, Madison SA, Derr JW Jr, Acland RD (1992) An extended approach for the vascular pedicle of the lateral arm free flap. Plast Reconstr Surg 89(2):259–267

    Article  CAS  PubMed  Google Scholar 

  33. Pelzer M, Reichenberger M, Germann G (2010) Osteo-periosteal-cutaneous flaps of the medial femoral condyle: a valuable modification for selected clinical situations. J Reconstr Microsurg 26(5):291–294

    Article  PubMed  Google Scholar 

  34. Reinisch JF, Winters R, Puckett CL (1984) The use of the osteocutaneous groin flap in gunshot wounds of the hand. J Hand Surg Am 9A(1):12–17

    Article  CAS  PubMed  Google Scholar 

  35. Sano K, Hallock GG, Hamazaki M, Daicyo Y (2004) The perforator-based conjoint (chimeric) medial Sural (MEDIAL GASTROCNEMIUS) free flap. Ann Plast Surg 53(6):588–592

    Article  PubMed  Google Scholar 

  36. Schmitt T, Talley J, Chang J (2012) New concepts and technologies in reconstructive hand surgery. Clin Plast Surg 39(4):445–451

    Article  PubMed  Google Scholar 

  37. Song R, Song Y, Yu Y (1982) The upper arm free flap. Clin Plast Surg 9(1):27–35

    CAS  PubMed  Google Scholar 

  38. Suzuki S, Koshima I (2011) Digital artery perforator flap for reconstruction of fingertip after resection of melanoma in situ. Hand Surg 16(3):395–398

    Article  PubMed  Google Scholar 

  39. Taylor GI (1983) The current status of free vascularized bone grafts. Clin Plast Surg 10(1):185–209

    CAS  PubMed  Google Scholar 

  40. Taylor GI, Doyle M, McCarten G (1990) The Doppler probe for planning flaps: anatomical study and clinical applications. Br J Plast Surg 43(1):1–16

    Article  CAS  PubMed  Google Scholar 

  41. Wei FC, Seah CS, Tsai YC, Liu SJ, Tsai MS (1994) Fibula osteoseptocutaneous flap for reconstruction of composite mandibular defects. Plast Reconstr Surg 93(2):294–304 (discussion 305–296)

  42. Yajima H, Tamai S, Yamauchi T, Mizumoto S (1999) Osteocutaneous radial forearm flap for hand reconstruction. J Hand Surg Am 24(3):594–603

    Article  CAS  PubMed  Google Scholar 

  43. Yazar S, Lin CH, Wei FC (2004) One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities. Plast Reconstr Surg 114(6):1457–1466

    Article  PubMed  Google Scholar 

  44. Yoshimatsu H, Yamamoto T, Iwamoto T, Narushima M, Iida T, Koshima I (2014) Toe digital artery perforator flap for coverage of defects on the toe. J Plast Reconstr Aesthet Surg 67(2):284–286

    Article  PubMed  Google Scholar 

  45. Yousif NJ, Dzwierzynski WW, Sanger JR, Matloub HS (1998) Sequential transfer of free flap to two defects. Plast Reconstr Surg 102(7):2431–2435

    Article  CAS  PubMed  Google Scholar 

  46. Yousif NJ, Ye Z, Grunert BK, Gosain AK, Matloub HS, Sanger JR (1998) Analysis of the distribution of cutaneous perforators in cutaneous flaps. Plast Reconstr Surg 101(1):72–84

    Article  CAS  PubMed  Google Scholar 

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Author notes

    Authors and Affiliations

    1. Department of Head and Neck Surgery, Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China

      Dajiang Song & Xiao Zhou

    2. Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China

      Dajiang Song

    3. Hand Surgical Centre, Nanhua Hospital, Nanhua University, Henyang, China

      Xiangwu Deng, Yanmin Chen & Songlin Xie

    4. Department of Orthopaedics, Xiangya Hospital of Central South University, Changsha, China

      Songlin Xie

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    1. Dajiang Song
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    2. Xiangwu Deng
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    3. Yanmin Chen
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    Correspondence to Songlin Xie or Xiao Zhou.

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    D. Song and X. Deng contributed equally to this work.

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    Song, D., Deng, X., Chen, Y. et al. Thinned chimeric radial collateral artery perforator flap in complex distal thumb reconstruction. Arch Orthop Trauma Surg 135, 1623–1631 (2015). https://doi.org/10.1007/s00402-015-2324-5

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