Reconstruction of the thumb tip using palmar neurovascular flaps
Objective Reconstruction of the tip of the thumb using a neurovascular flap. Indications Transverse defects of the thumb’s tip or large defects of the palmar pulp (max. 2.0–2.5 cm) with exposure of bone and/or tendons. Contraindications Extensive crush injury, heavy wound contamination, circulatory...
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| Published in: | Operative Orthopädie und Traumatologie Vol. 24; no. 2; pp. 116 - 121 |
|---|---|
| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Berlin/Heidelberg
Springer-Verlag
01-04-2012
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| Abstract | Objective
Reconstruction of the tip of the thumb using a neurovascular flap.
Indications
Transverse defects of the thumb’s tip or large defects of the palmar pulp (max. 2.0–2.5 cm) with exposure of bone and/or tendons.
Contraindications
Extensive crush injury, heavy wound contamination, circulatory disorders, acute infection, very large defects (> 2.0–2.5 cm finger length), circumferential soft tissue defects, and previous defects/operations (relative).
Surgical technique
Supine position, hand supinated, tourniquet, loupe magnification. Mid-lateral incisions along both sides of the finger running from the defect to the interphalangeal joint (small defect) or proceeding further proximally. Careful elevation of the flap including both neurovascular bundles leaving dorsal branches of the bundles (long fingers only) and the flexor tendon sheath intact. Suture of the flap in either flexion position (i.e., advancement flap) (Moberg) or by creating an island-flap through an additional transverse skin incision along the flap’s base (O’Brien). Finally, closure of the defect at the flap’s base using a full thickness skin graft, Z plasty, or V-Y plasty.
Postoperative management
Plaster cast (finger slightly flexed) for 2 weeks.
Results
Reliable method. Good functional results with good sensibility and only minor reduction in range of motion. |
|---|---|
| AbstractList | Objective
Reconstruction of the tip of the thumb using a neurovascular flap.
Indications
Transverse defects of the thumb’s tip or large defects of the palmar pulp (max. 2.0–2.5 cm) with exposure of bone and/or tendons.
Contraindications
Extensive crush injury, heavy wound contamination, circulatory disorders, acute infection, very large defects (> 2.0–2.5 cm finger length), circumferential soft tissue defects, and previous defects/operations (relative).
Surgical technique
Supine position, hand supinated, tourniquet, loupe magnification. Mid-lateral incisions along both sides of the finger running from the defect to the interphalangeal joint (small defect) or proceeding further proximally. Careful elevation of the flap including both neurovascular bundles leaving dorsal branches of the bundles (long fingers only) and the flexor tendon sheath intact. Suture of the flap in either flexion position (i.e., advancement flap) (Moberg) or by creating an island-flap through an additional transverse skin incision along the flap’s base (O’Brien). Finally, closure of the defect at the flap’s base using a full thickness skin graft, Z plasty, or V-Y plasty.
Postoperative management
Plaster cast (finger slightly flexed) for 2 weeks.
Results
Reliable method. Good functional results with good sensibility and only minor reduction in range of motion. Reconstruction of the tip of the thumb using a neurovascular flap. Transverse defects of the thumb's tip or large defects of the palmar pulp (max. 2.0-2.5 cm) with exposure of bone and/or tendons. Extensive crush injury, heavy wound contamination, circulatory disorders, acute infection, very large defects (> 2.0-2.5 cm finger length), circumferential soft tissue defects, and previous defects/operations (relative). Supine position, hand supinated, tourniquet, loupe magnification. Mid-lateral incisions along both sides of the finger running from the defect to the interphalangeal joint (small defect) or proceeding further proximally. Careful elevation of the flap including both neurovascular bundles leaving dorsal branches of the bundles (long fingers only) and the flexor tendon sheath intact. Suture of the flap in either flexion position (i.e., advancement flap) (Moberg) or by creating an island-flap through an additional transverse skin incision along the flap's base (O'Brien). Finally, closure of the defect at the flap's base using a full thickness skin graft, Z plasty, or V-Y plasty. Plaster cast (finger slightly flexed) for 2 weeks. Reliable method. Good functional results with good sensibility and only minor reduction in range of motion. OBJECTIVEReconstruction of the tip of the thumb using a neurovascular flap. INDICATIONSTransverse defects of the thumb's tip or large defects of the palmar pulp (max. 2.0-2.5 cm) with exposure of bone and/or tendons. CONTRAINDICATIONSExtensive crush injury, heavy wound contamination, circulatory disorders, acute infection, very large defects (> 2.0-2.5 cm finger length), circumferential soft tissue defects, and previous defects/operations (relative). SURGICAL TECHNIQUESupine position, hand supinated, tourniquet, loupe magnification. Mid-lateral incisions along both sides of the finger running from the defect to the interphalangeal joint (small defect) or proceeding further proximally. Careful elevation of the flap including both neurovascular bundles leaving dorsal branches of the bundles (long fingers only) and the flexor tendon sheath intact. Suture of the flap in either flexion position (i.e., advancement flap) (Moberg) or by creating an island-flap through an additional transverse skin incision along the flap's base (O'Brien). Finally, closure of the defect at the flap's base using a full thickness skin graft, Z plasty, or V-Y plasty. POSTOPERATIVE MANAGEMENTPlaster cast (finger slightly flexed) for 2 weeks. RESULTSReliable method. Good functional results with good sensibility and only minor reduction in range of motion. |
| Author | Schmidt, K. Harenberg, P.S. Jakubietz, M.G. Meffert, R.H. Jakubietz, R.G. |
| Author_xml | – sequence: 1 givenname: P.S. surname: Harenberg fullname: Harenberg, P.S. email: harenberg@uni-hd.de organization: Department of Trauma, Hand, Plastic, and Reconstructive Surgery, University Hospital Würzburg – sequence: 2 givenname: R.G. surname: Jakubietz fullname: Jakubietz, R.G. organization: Department of Trauma, Hand, Plastic, and Reconstructive Surgery, University Hospital Würzburg – sequence: 3 givenname: M.G. surname: Jakubietz fullname: Jakubietz, M.G. organization: Department of Trauma, Hand, Plastic, and Reconstructive Surgery, University Hospital Würzburg – sequence: 4 givenname: K. surname: Schmidt fullname: Schmidt, K. organization: Department of Trauma, Hand, Plastic, and Reconstructive Surgery, University Hospital Würzburg – sequence: 5 givenname: R.H. surname: Meffert fullname: Meffert, R.H. organization: Department of Trauma, Hand, Plastic, and Reconstructive Surgery, University Hospital Würzburg |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/22430376$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1016/S0363-5023(83)80014-8 10.1097/PRS.0b013e3181823be0 10.2106/00004623-197052050-00006 10.1097/00006534-197903000-00008 10.1053/jhsu.2002.30921 10.2106/00004623-196446040-00011 10.1001/jama.1947.62880010007007 10.1016/S0363-5023(84)80242-7 10.1054/bjps.1997.3005 10.1016/0007-1226(85)90007-4 10.1016/S0007-1226(68)80033-5 10.1016/S0363-5023(09)91123-6 10.1016/S0363-5023(85)80068-X 10.1007/s00064-008-1233-y 10.1016/S0363-5023(96)80016-5 10.1007/BF02579748 10.1302/0301-620X.57B4.491 |
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| DocumentTitle_FL | Rekonstruktion der Daumenkuppe mit palmaren neurovaskulären Lappen |
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| Keywords | Neurovascular flap Insellappen Fingerkuppe Fingertip Island flap Neurovaskulärer Lappen Dehnungslappen Advancement flap |
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| References | WallaceJ Bone Joint Surg Br19755749111943181:STN:280:DyaE28%2FmvFektA%3D%3D StrauchJ Hand Surg Am199015148229915610.1016/S0363-5023(09)91123-61:STN:280:DyaK3c7jtFKksQ%3D%3D LemmonPlast Reconstr Surg2008122105e1876602810.1097/PRS.0b013e3181823be0 KutlerJ Am Med Assoc1947133292027755610.1001/jama.1947.628800100070071:STN:280:DyaH2s%2FjvFSksg%3D%3D MehlingOper Orthop Traumatol2008201031853579510.1007/s00064-008-1233-y EppingOper Orthop Traumatol1992419510.1007/BF02579748 LucasJ Hand Surg Am1984944867259071:STN:280:DyaL2c3htlymtw%3D%3D MobergJ Bone Joint Surg Am196446817141610941:STN:280:DyaF2c7hvFSltQ%3D%3D AtasoyJ Bone Joint Surg Am19705292149209061:STN:280:DyaE3M%2Fjt12jtA%3D%3D SegmullerHandchirurgie19768759924901:STN:280:DyaE2s%2FkvFyntA%3D%3D FoucherPlast Reconstr Surg19796334436883710.1097/00006534-197903000-000081:STN:280:DyaE1M7hs1Gruw%3D%3D MossJ Hand Surg Am19851047340200571:STN:280:DyaL2M3mt1KgsQ%3D%3D FoucherBr J Plast Surg199952641034359310.1054/bjps.1997.30051:STN:280:DyaK1M3nsFSlsw%3D%3D LoganBr J Plast Surg198538497405270910.1016/0007-1226(85)90007-41:STN:280:DyaL28%2Fis12jtA%3D%3D LindseyJ Hand Surg Am199621626884295610.1016/S0363-5023(96)80016-51:STN:280:DyaK28vktVKntw%3D%3D DellonJ Hand Surg Am1983819068337291:STN:280:DyaL3s7mt1WqtQ%3D%3D BaumeisterJ Hand Surg Am2002271051181062310.1053/jhsu.2002.30921 OBr J Plast Surg19682125810.1016/S0007-1226(68)80033-5 4920906 - J Bone Joint Surg Am. 1970 Jul;52(5):921-6 8842956 - J Hand Surg Am. 1996 Jul;21(4):626-33 992490 - Handchirurgie. 1976;8(2):75-6 6833729 - J Hand Surg Am. 1983 Mar;8(2):190-4 368837 - Plast Reconstr Surg. 1979 Mar;63(3):344-9 6725907 - J Hand Surg Am. 1984 May;9(3):448-50 18766028 - Plast Reconstr Surg. 2008 Sep;122(3):105e-117e 18535795 - Oper Orthop Traumatol. 2008 Jun;20(2):103-10 10343593 - Br J Plast Surg. 1999 Jan;52(1):64-8 20277556 - J Am Med Assoc. 1947 Jan 4;133(1):29 2299156 - J Hand Surg Am. 1990 Jan;15(1):148-54 11810623 - J Hand Surg Am. 2002 Jan;27(1):105-14 1194318 - J Bone Joint Surg Br. 1975 Nov;57(4):491-4 4052709 - Br J Plast Surg. 1985 Oct;38(4):497-500 14161094 - J Bone Joint Surg Am. 1964 Jun;46:817-25 4020057 - J Hand Surg Am. 1985 Jul;10(4):473-82 4877607 - Br J Plast Surg. 1968 Jul;21(3):258-61 Moss (81_CR2) 1985; 10 Lucas (81_CR3) 1984; 9 Kutler (81_CR8) 1947; 133 Lemmon (81_CR6) 2008; 122 Logan (81_CR12) 1985; 38 Mehling (81_CR18) 2008; 20 O (81_CR9) 1968; 21 Lindsey (81_CR4) 1996; 21 Segmuller (81_CR10) 1976; 8 Baumeister (81_CR17) 2002; 27 Strauch (81_CR1) 1990; 15 Wallace (81_CR5) 1975; 57 Foucher (81_CR11) 1979; 63 Epping (81_CR14) 1992; 4 Moberg (81_CR13) 1964; 46 Atasoy (81_CR7) 1970; 52 Dellon (81_CR15) 1983; 8 Foucher (81_CR16) 1999; 52 |
| References_xml | – volume: 8 start-page: 190 year: 1983 ident: 81_CR15 publication-title: J Hand Surg Am doi: 10.1016/S0363-5023(83)80014-8 contributor: fullname: Dellon – volume: 122 start-page: 105e year: 2008 ident: 81_CR6 publication-title: Plast Reconstr Surg doi: 10.1097/PRS.0b013e3181823be0 contributor: fullname: Lemmon – volume: 52 start-page: 921 year: 1970 ident: 81_CR7 publication-title: J Bone Joint Surg Am doi: 10.2106/00004623-197052050-00006 contributor: fullname: Atasoy – volume: 63 start-page: 344 year: 1979 ident: 81_CR11 publication-title: Plast Reconstr Surg doi: 10.1097/00006534-197903000-00008 contributor: fullname: Foucher – volume: 27 start-page: 105 year: 2002 ident: 81_CR17 publication-title: J Hand Surg Am doi: 10.1053/jhsu.2002.30921 contributor: fullname: Baumeister – volume: 46 start-page: 817 year: 1964 ident: 81_CR13 publication-title: J Bone Joint Surg Am doi: 10.2106/00004623-196446040-00011 contributor: fullname: Moberg – volume: 133 start-page: 29 year: 1947 ident: 81_CR8 publication-title: J Am Med Assoc doi: 10.1001/jama.1947.62880010007007 contributor: fullname: Kutler – volume: 9 start-page: 448 year: 1984 ident: 81_CR3 publication-title: J Hand Surg Am doi: 10.1016/S0363-5023(84)80242-7 contributor: fullname: Lucas – volume: 52 start-page: 64 year: 1999 ident: 81_CR16 publication-title: Br J Plast Surg doi: 10.1054/bjps.1997.3005 contributor: fullname: Foucher – volume: 38 start-page: 497 year: 1985 ident: 81_CR12 publication-title: Br J Plast Surg doi: 10.1016/0007-1226(85)90007-4 contributor: fullname: Logan – volume: 21 start-page: 258 year: 1968 ident: 81_CR9 publication-title: Br J Plast Surg doi: 10.1016/S0007-1226(68)80033-5 contributor: fullname: O – volume: 8 start-page: 75 year: 1976 ident: 81_CR10 publication-title: Handchirurgie contributor: fullname: Segmuller – volume: 15 start-page: 148 year: 1990 ident: 81_CR1 publication-title: J Hand Surg Am doi: 10.1016/S0363-5023(09)91123-6 contributor: fullname: Strauch – volume: 10 start-page: 473 year: 1985 ident: 81_CR2 publication-title: J Hand Surg Am doi: 10.1016/S0363-5023(85)80068-X contributor: fullname: Moss – volume: 20 start-page: 103 year: 2008 ident: 81_CR18 publication-title: Oper Orthop Traumatol doi: 10.1007/s00064-008-1233-y contributor: fullname: Mehling – volume: 21 start-page: 626 year: 1996 ident: 81_CR4 publication-title: J Hand Surg Am doi: 10.1016/S0363-5023(96)80016-5 contributor: fullname: Lindsey – volume: 4 start-page: 195 year: 1992 ident: 81_CR14 publication-title: Oper Orthop Traumatol doi: 10.1007/BF02579748 contributor: fullname: Epping – volume: 57 start-page: 491 year: 1975 ident: 81_CR5 publication-title: J Bone Joint Surg Br doi: 10.1302/0301-620X.57B4.491 contributor: fullname: Wallace |
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| Snippet | Objective
Reconstruction of the tip of the thumb using a neurovascular flap.
Indications
Transverse defects of the thumb’s tip or large defects of the palmar... Reconstruction of the tip of the thumb using a neurovascular flap. Transverse defects of the thumb's tip or large defects of the palmar pulp (max. 2.0-2.5 cm)... OBJECTIVEReconstruction of the tip of the thumb using a neurovascular flap. INDICATIONSTransverse defects of the thumb's tip or large defects of the palmar... |
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| SubjectTerms | Anatomy Hand Surgery Humans Medicine Medicine & Public Health Operative Techniken Orthopedics Plastic Surgery Reconstructive Surgical Procedures - mortality Surgical Flaps Surgical Orthopedics Thumb - surgery Traumatic Surgery Treatment Outcome |
| Title | Reconstruction of the thumb tip using palmar neurovascular flaps |
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