Öz
Introduction:
Many methods have been described in the literature for the reconstruction of upper extremity defects that may occur as a result of various etiological reasons. Among these methods, local or regional flaps are used quite frequently, and most defects can be successfully reconstructed. However, in some large and complex defects, technically more difficult free flap options may be unavoidable. In our study, we present our experience on upper extremity reconstruction with free flaps.
Materials and Methods:
Between 2015 and 2021, 9 patients (3 Female, 6 Male) underwent upper extremity reconstructions with free flaps. The ages of the patients ranged from 22 to 68 years. Our free flap choices included anterolateral thigh flap in 4 patients, latissimus dorsi free flap in 4 patients, and radial forearm free flap in 1 patient. Defects of patients were including dorsum of the hand in 3 patients, an amputation stump in 1 patient, the dorsum of the hand with the forearm in 2 patients, and the elbow with the forearm in 3 patients.
Results:
The radial artery was chosen as the recipient artery in all patients. The concomitant vein of the radial artery or the superficial venous system was used as the recipient vein. End-to-end anastomosis was performed in 6 patients and end-to-side anastomosis was performed in 3 patients. Arterial thrombosis was observed in 1 patient and venous thrombosis was observed in 1 patient. Both patients were taken to early salvage surgery, the anastomoses were renewed and the flaps were salvaged. No additional complications were observed in other patients. There was no flap loss in our clinical series.
Conclusion:
Free flaps can be used safely for upper extremity soft tissue reconstructions in appropriate cases. Although it requires technical experience, we believe that perforator-based free flaps are quite advantageous due to minimal donor site problems and can be safely chosen as the first method in suitable patients.
Anahtar Kelimeler
Kaynakça
- Duymaz A, Karabekmez F E, Keskin M,Tosun Z,Savaci N Dirsek bölgesi yumuşak doku defektlerinin rekonstrüksiyonu: Tedavi algoritma önerisi. Ulusal Travma ve Acil Cerrahi Dergisi. 2009; 15 (6): 591 - 8.
- Axelrod TS, Buchler U. Severe complex injuries to the upper extremity: revascularization and replantation. J Hand Surg Am. 1991 Jul; 16 (4): 574-84.
- Flurry M, Melissinos EG, Livingston CK. Composite forearm free fillet flaps to preserve stump length following traumatic amputations of the upper extremity. Ann Plast Surg. 2008 Apr; 60 (4): 391-4.
- He J, Qing L, Wu P, Zhou Z, Yu F, Zhang X, Tang J. Customized reconstruction of complex soft tissue defects in the upper extremities with variants of double skin paddle anterolateral thigh perforator flap. Injury. 2021 Jul; 52 (7): 1771-7.
- Wu G, Zhang Z, Zhang F, Zhang Y, Wang Q, Yu W. The free flap based on a single proximal perforator of the radial artery: ultrasonography study and clinical applications in reconstruction of soft tissue defects in finger. Eur J Med Res. 2022 Jun 4; 27 (1): 85.
- Koschnick M, Bruener S, Germann G. Free tissue transfer: an advanced strategy for postinfection soft-tissue defects in the upper extremity. Ann Plast Surg. 2003 Aug; 51 (2): 147-54.
- Kelada MN, Salem RR, Eltohfa YA, Ghozlan NA, Kholosy HM. "Posterior interosseus artery flap for hand reconstruction: anatomical basis and clinical application". BMC Musculoskelet Disord. 2022 Jul 12; 23 (1):662.
- Gerakopoulos E, Colegate-Stone T, O'Connor EF, Rose V. The use of the anterolateral thigh vascular free flap in complex open elbow fractures after major trauma - An illustrated report of an interesting case. Trauma Case Rep. 2021 Mar 17; 34: 00463.
- Kahramangil B, Pires G, Ghaznavi AM. Flap survival and functional outcomes in elbow soft tissue reconstruction: A 25-year systematic review. J Plast Reconstr Aesthet Surg. 2022 Mar; 75 (3): 991-1000.
- Qing L, Li X, Wu P, Zhou Z, Yu F, Tang J. Customized reconstruction of complex soft-tissue defect in the hand and forearm with individual design of chain-linked bilateral anterolateral thigh perforator flaps. J Plast Reconstr Aesthet Surg. 2019 Dec; 72 (12): 1909-16.
- Kim SW, Hwang KT, Kim JD, Kim YH. Reconstruction of postinfected scalp defects using latissimus dorsi perforator and myocutaneous free flaps. J Craniofac Surg. 2012 Nov; 23 (6): 1615-9.
- Ooi A, Ng J, Chui C, Goh T, Tan BK. Maximizing Outcomes While Minimizing Morbidity: An Illustrated Case Review of Elbow Soft Tissue Reconstruction. Plast Surg Int. 2016; 2016: 2841816.
- Chuang DC. Nerve transfer with functioning free muscle transplantation. Hand Clin. 2008 Nov; 24 (4): 377-88
Öz
Amaç:
Çeşitli etiyolojik nedenler sonucu ortaya çıkabilen üst ekstremite defektlerinin rekonstrüksiyonu için literatürede pek çok yöntem tanımlanmıştır. Bu yöntemler arasında lokal veya bölgesel flepler oldukça sık kullanılmakta olup çoğu defekt başarılı bir şekilde rekonstrükte edilebilmektedir. Bununla birlikte bazı büyük ve kompleks defektlerde, teknik olarak daha zor olan serbest flep seçenekleri kaçınılmaz olabilmektedir. Çalışmamızda serbest fleplerle üst ekstremite rekonstrüksiyonu hakkındaki tecrübelerimizi sunmayı planladık.
Gereç ve Yöntem:
2015 - 2021 yılları arasında 9 hastada (3 Kadın, 6 Erkek) serbest fleplerle üst ekstremite rekonstrüksiyonu uygulandı. Hastaların yaşları 22-68 arasında değişmekteydi. Serbest flep tercihlerimiz arasında 4 hastada anterolateral uyluk flebi, 4 hastada latissimus dorsi serbest flebi ve 1 hastada radial ön kol serbest flebi yer almaktaydı. Hastaların defektleri; 3 hastada el dorsumu, 1 hastada amputasyon güdüğü, 2 hastada ön kol ile birlikte el dorsumu ve 3 hastada ön kol ile birlikte dirsekte bulunmaktaydı.
Bulgular:
Bütün hastalarda alıcı arter olarak radial arter seçildi. Alıcı ven olarak, radial arterin konkomitan veni veya yüzeyel venöz sistem kullanıldı. 6 hastada uç-uca, 3 hastada uç-yan anastomoz yapıldı.1 hastada arteriyel tromboz ve 1 hastada venöz tromboz gözlendi. İki hasta da erken dönem kurtarma cerrahisine alınarak anastomoz hatları yenilendi ve flepler kurtarıldı. Diğer hastalarda ek komplikasyon izlenmedi. Klinik serimizde flep kaybı yaşanmadı.
Sonuç:
Uygun vakalarda, üst ekstremite yumuşak doku rekonstrüksiyonları için serbest flepler güvenle kullanılabilir. Teknik deneyim gerektirmekle beraber, minimal donör saha problemleri nedeniyle perforatör tabanlı serbest fleplerin oldukça avantajlı olduğu ve uygun hastalarda ilk yöntem olarak güvenle seçilebileceği kanaatindeyiz.
Anahtar Kelimeler
Destekleyen Kurum
yok
Teşekkür
yok
Kaynakça
- Duymaz A, Karabekmez F E, Keskin M,Tosun Z,Savaci N Dirsek bölgesi yumuşak doku defektlerinin rekonstrüksiyonu: Tedavi algoritma önerisi. Ulusal Travma ve Acil Cerrahi Dergisi. 2009; 15 (6): 591 - 8.
- Axelrod TS, Buchler U. Severe complex injuries to the upper extremity: revascularization and replantation. J Hand Surg Am. 1991 Jul; 16 (4): 574-84.
- Flurry M, Melissinos EG, Livingston CK. Composite forearm free fillet flaps to preserve stump length following traumatic amputations of the upper extremity. Ann Plast Surg. 2008 Apr; 60 (4): 391-4.
- He J, Qing L, Wu P, Zhou Z, Yu F, Zhang X, Tang J. Customized reconstruction of complex soft tissue defects in the upper extremities with variants of double skin paddle anterolateral thigh perforator flap. Injury. 2021 Jul; 52 (7): 1771-7.
- Wu G, Zhang Z, Zhang F, Zhang Y, Wang Q, Yu W. The free flap based on a single proximal perforator of the radial artery: ultrasonography study and clinical applications in reconstruction of soft tissue defects in finger. Eur J Med Res. 2022 Jun 4; 27 (1): 85.
- Koschnick M, Bruener S, Germann G. Free tissue transfer: an advanced strategy for postinfection soft-tissue defects in the upper extremity. Ann Plast Surg. 2003 Aug; 51 (2): 147-54.
- Kelada MN, Salem RR, Eltohfa YA, Ghozlan NA, Kholosy HM. "Posterior interosseus artery flap for hand reconstruction: anatomical basis and clinical application". BMC Musculoskelet Disord. 2022 Jul 12; 23 (1):662.
- Gerakopoulos E, Colegate-Stone T, O'Connor EF, Rose V. The use of the anterolateral thigh vascular free flap in complex open elbow fractures after major trauma - An illustrated report of an interesting case. Trauma Case Rep. 2021 Mar 17; 34: 00463.
- Kahramangil B, Pires G, Ghaznavi AM. Flap survival and functional outcomes in elbow soft tissue reconstruction: A 25-year systematic review. J Plast Reconstr Aesthet Surg. 2022 Mar; 75 (3): 991-1000.
- Qing L, Li X, Wu P, Zhou Z, Yu F, Tang J. Customized reconstruction of complex soft-tissue defect in the hand and forearm with individual design of chain-linked bilateral anterolateral thigh perforator flaps. J Plast Reconstr Aesthet Surg. 2019 Dec; 72 (12): 1909-16.
- Kim SW, Hwang KT, Kim JD, Kim YH. Reconstruction of postinfected scalp defects using latissimus dorsi perforator and myocutaneous free flaps. J Craniofac Surg. 2012 Nov; 23 (6): 1615-9.
- Ooi A, Ng J, Chui C, Goh T, Tan BK. Maximizing Outcomes While Minimizing Morbidity: An Illustrated Case Review of Elbow Soft Tissue Reconstruction. Plast Surg Int. 2016; 2016: 2841816.
- Chuang DC. Nerve transfer with functioning free muscle transplantation. Hand Clin. 2008 Nov; 24 (4): 377-88
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Eylül 2022 |
| Gönderilme Tarihi | 22 Temmuz 2022 |
| Yayımlandığı Sayı | Yıl 2022 |