J Korean Soc Surg Hand.  2014 Mar;19(1):29-35. 10.12790/jkssh.2014.19.1.29.

Efficiency of Vein Repair for Distally Based Avulsion Flap Injury of the Hand and Forearm

• Kang DH
• Kim JH
• Nam HJ
• Cheon HJ
• Kim YW
• Woo SH

• KMID: 1896924
• DOI: http://doi.org/10.12790/jkssh.2014.19.1.29

Abstract

PURPOSE
The purpose was to evaluate the efficiency of vein repair on flap survival in distally based avulsion flap injury of the hand and forearm.
METHODS
Sixteen cases of distally based avulsion flap injury larger than 30 cm2 in size of the hand and forearm in which vein repair was done were enrolled. All had a avulsion injury by rolling machine. To survive the flap, extensive debridement was done to reduce the size of distally based flap injury as little as possible. Thereafter, an average of 1.4 vein were repaired. Postoperatively, hyberbaric oxygen therapy was performed for 2 weeks. The flap survival was assessed at three weeks after operation.
RESULTS
When comparing the size of distally based avulsion flap injury and flaps that survived after operation, excellent results were observed in 12 cases, and good results in 4 cases. Additional operation was required including split thickness skin graft in 4 cases. A reverse island fasciocutaneous flap was performed in one case, and elbow joint arthrolysis was performed in another one.
CONCLUSION
Treatment of distally based avulsion flap injury of the hand and forearm using vein repair lead to relatively satisfying results in flap survival by allowing earlier motion of the joint, providing favorable functional results.

Keyword

Distally based avulsion flap injury; Vein repair

MeSH Terms

Debridement
Elbow Joint
Forearm*
Hand*
Joints
Oxygen
Skin
Transplants
Veins*
Oxygen

Figure

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  Fig. 1. (A) Distally based avulsion flap injury involving dorsum of the left hand with phalangeal comminuted open fractures of index and long finger. (B) Microscopic photograph of vein repair for dorsum of the hand. (C) Radiograph of preoperative state. (D) Radiograph of immediate postoperative state. (E) Flap survival 3 weeks after operation. (F, G) Complete survival of the flap 6 months after operation with acceptable cosmetic appearance and normal range of motion of fingers. (H) Radiological bone union 6 months after operation.

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  Fig. 2. (A-C) Distally based avulsion flap injury involving palm and dorsum of the right hand with thumb pulp avulsion amputation. (D) Photograph of vein repair for dorsum of the hand. (E) Flap to graft conversion technique. (F) Wound closure after massive debridement. (G, H) Flap survival 6 months after operation with acceptable cosmetic appearance and normal range of motion of fingers.

• 

  Fig. 3. (A) Distally based avulsion flap injury involving right forearm with multiple forearm muscle ruptures. (B, C) Forearm superficial vein repair (basilar and cephalic vein). (D) Wound closure after massive debridement. (E) Flap survival 3 weeks after operation. (F) Skin graft done. (G, H). Flap survival 6 months after operation with acceptable cosmetic appearance and normal range of motion of elbow joint after arthrolysis (flexion contracture 15° and further flexion 110°)

Reference

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