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DOI: 10.5999/aps.2016.43.6.551
Fascial Free Flap for Reconstruction of the Dorsolateral Hand and Digits: The Advantage of a Thin Contour
Background Fascial free flaps have been widely used for reconstruction of the hand because they are thin. However, studies reporting objective data regarding the advantages of this approach are lacking. Thus, we report our experience with such flaps.
Methods Forty-five cases of fascial free flaps between November 2006 and March 2014 were reviewed. Nine cases involving reconstructed dorsal or lateral defects were included. Four anterolateral thigh fascial free flaps and 5 lateral arm fascial free flaps were examined. Maximal flap contour was assessed by measuring reconstructed tissue thickness at the central area from the surface of the skin to below the bone in a vertical manner using ultrasonography and X-ray data. Contralateral regions were examined in the same manner and a comparative analysis was performed. A questionnaire survey regarding aesthetic satisfaction was also administered.
Results All reconstructed parts had a thicker contour than the contralateral side. The average relative percentage of reconstructed tissue thickness was found to be 152% using ultrasonography and 143% using X-ray imaging. According to the aesthetic satisfaction survey, the average rate of satisfaction for patients was 62%, and satisfaction with the flap contour was 72%.
Conclusions Using a fascial free flap, the reconstructed tissue was approximately 1.5× as thick as the contour of the normal side, which led to positive responses regarding aesthetic satisfaction.
Publication History
Received: 12 May 2016
Accepted: 28 September 2016
Article published online:
20 April 2022
© 2016. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
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References
- 1 Smith RA. The free fascial scalp flap. Plast Reconstr Surg 1980; 66: 204-209
- 2 Upton J, Rogers C, Durham-Smith G. et al. Clinical applications of free temporoparietal flaps in hand reconstruction. J Hand Surg Am 1986; 11: 475-483
- 3 Brent B, Upton J, Acland RD. et al. Experience with the temporoparietal fascial free flap. Plast Reconstr Surg 1985; 76: 177-188
- 4 Carty MJ, Taghinia A, Upton J. Fascial flap reconstruction of the hand: a single surgeon's 30-year experience. Plast Reconstr Surg 2010; 125: 953-962
- 5 Taghinia AH, Carty M, Upton J. Fascial flaps for hand reconstruction. J Hand Surg Am 2010; 35: 1351-1355
- 6 Hsieh CH, Yang CC, Kuo YR. et al. Free anterolateral thigh adipofascial perforator flap. Plast Reconstr Surg 2003; 112: 976-982
- 7 Reyes FA, Burkhalter WE. The fascial radial flap. J Hand Surg Am 1988; 13: 432-437
- 8 Yousif NJ, Warren R, Matloub HS. et al. The lateral arm fascial free flap: its anatomy and use in reconstruction. Plast Reconstr Surg 1990; 86: 1138-1145
- 9 Chen HC, el-Gammal TA. The lateral arm fascial free flap for resurfacing of the hand and fingers. Plast Reconstr Surg 1997; 99: 454-459
- 10 Chung KC, Pillsbury MS, Walters MR. et al. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am 1998; 23: 575-587
- 11 Kimura N, Satoh K. Consideration of a thin flap as an entity and clinical applications of the thin anterolateral thigh flap. Plast Reconstr Surg 1996; 97: 985-992
- 12 Kimura N, Satoh K, Hasumi T. et al. Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients. Plast Reconstr Surg 2001; 108: 1197-1208
- 13 Koshima I, Fukuda H, Yamamoto H. et al. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg 1993; 92: 421-428
- 14 Nojima K, Brown SA, Acikel C. et al. Defining vascular supply and territory of thinned perforator flaps: part I. Anterolateral thigh perforator flap. Plast Reconstr Surg 2005; 116: 182-193
- 15 Alkureishi LW, Shaw-Dunn J, Ross GL. Effects of thinning the anterolateral thigh flap on the blood supply to the skin. Br J Plast Surg 2003; 56: 401-408
- 16 Ross GL, Dunn R, Kirkpatrick J. et al. To thin or not to thin: the use of the anterolateral thigh flap in the reconstruction of intraoral defects. Br J Plast Surg 2003; 56: 409-413
- 17 Wu LC, Gottlieb LJ. Glabrous dermal grafting: a 12-year experience with the functional and aesthetic restoration of palmar and plantar skin defects. Plast Reconstr Surg 2005; 116: 1679-1685
- 18 Friel MT, Duquette SP, Ranganath B. et al. The use of glabrous dkins grafts in the treatment of pediatric palmar hand burns. Ann Plast Surg 2015; 75: 153-157
- 19 Adani R, Tarallo L, Marcoccio I. et al. Hand reconstruction using the thin anterolateral thigh flap. Plast Reconstr Surg 2005; 116: 467-473
- 20 Thankappan K, Kuriakose MA, Chatni SS. et al. Lateral arm free flap for oral tongue reconstruction: an analysis of surgical details, morbidity, and functional and aesthetic outcome. Ann Plast Surg 2011; 66: 261-266
- 21 Nakayama B, Hyodo I, Hasegawa Y. et al. Role of the anterolateral thigh flap in head and neck reconstruction: advantages of moderate skin and subcutaneous thickness. J Reconstr Microsurg 2002; 18: 141-146