Arch Hand Microsurg.  2020 Jun;25(2):156-160. 10.12790/ahm.20.0007.

One Stage Microsurgical Reconstruction with Chimeric Flap for Salvaging a Complex Hand Injuries

• Suondoh MS
• Sulaiman WAW
• Ismail WFW
• Saad AZM

• KMID: 2502714
• DOI: http://doi.org/10.12790/ahm.20.0007

Abstract

Hand injuries, involving extensor tendon with carpal bone loss are catastrophic events. Reconstructive surgeons typically face difficulties in minimizing the number of operations, recovery period and restoring its functions with an acceptable aesthetic outcome. However, chimeric flap, which consists of multiple composite flaps from one of the sources of main vascular system is a promising option for reconstruction. This paper presents a case of near-amputated degloving injury over the extensor tendon with carpal bone loss on left hand due to road traffic accidents. The patient had a hand reconstruction with chimeric flap consisted of free fasciocutaneous anterolateral thigh flap and vascularized osteomyocutaneous iliac bone graft with tensor fascia lata from the lateral circumflex femoral vascular system. As a result, the hand functioned well and appeared aesthetically acceptable. Thus, this surgery is an effective option in recovering and reconstructing a complex and traumatic hand injury that involved multiple composite tissue defects.

Keyword

Hand injuries; Extensor tendon; Carpal bones; Chimeric flap

Figure

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  Fig. 1. (A) Left forearm wound and (B) X-ray of left forearm, lateral view.

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  Fig. 2. Defects wound after debridement. ED, extensor digitorum; EDM, extensor digiti minimi; ECU, extensor carpi ulnaris.

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  Fig. 3. (A) Chimeric flap of free fasciocutaneous anterolateral thigh flap with fascia lata and vascularized osteomyocutaneous iliac bone graft. (B) Vascular anastomoses between recipient and donor vessels. (C) Vascularized iliac bone graft was inserted to cover the carpal bone defect and K-wire was inserted from the metacarpal bone through iliac bone graft. Locking plate was applied across the metacarpal bone. (D) Fascia lata slit into small strips and laid down on top of bone as vascularised tendon grafts for the extensor tendon defects. (E) Immediate result after flap inset. LCFA, lateral circumflex femoral artery; TLCFA, transverse branch of LCFA; DLCFA, descending branch of LCFA.

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  Fig. 4. Flap debulking and tenolysis surgery.

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  Fig. 5. (A) Dorsum part of the left forearm in full extensor. (B) Stiffness of ring and little fingers of left hand. (C) X-ray of left forearm after 1 year, anteroposterior view.

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