Soft tissue coverage in devastating hand injuries.

Plastic surgical therapy of mutilating hand injuries represents a multifaceted task to the hand surgeon, where considerations about indication, timing, and structure of the soft tissue coverage play a major role in reconstruction. The concept of early primary reconstruction (including emergency procedures) and fast rehabilitation not only demands thoughtful tissue preparation but also mastering of a bandwidth of plastic surgical techniques. Systematic algorithms based on the reconstructive ladder help in decision making in the complexity of soft tissue coverage but have to be adjusted to the individual case profile. General considerations and strategic planning are explained and illustrated by three clinical cases.

[1]  Jui-yung Yang.  The First Dorsal Metacarpal Flap in First Web Space and Thumb Reconstruction , 1991, Annals of plastic surgery.

[2]  W. Mühlbauer,et al.  The Forearm Flap , 1982, Plastic and reconstructive surgery.

[3]  F. Wei,et al.  Groin flap design and versatility. , 1989, Plastic and reconstructive surgery.

[4]  L. Levin,et al.  Primary and secondary microvascular reconstruction of the upper extremity. , 2001, Hand clinics.

[5]  A. Gilbert,et al.  Le lambeau cubital , 1988 .

[6]  M. Ninkovic,et al.  Emergency Free Tissue Transfer for Severe Upper Extremity Injuries , 1995, Journal of hand surgery.

[7]  J. Boyes,et al.  Paint-gun injuries of the hand. , 1967, The Journal of bone and joint surgery. American volume.

[8]  J. Upton,et al.  Clinical applications of free temporoparietal flaps in hand reconstruction. , 1986, Journal of Hand Surgery-American Volume.

[9]  Y. Inada,et al.  Radical forearm flap with vascularized tendons for hand reconstruction. , 1996, Plastic and reconstructive surgery.

[10]  J. Sanger,et al.  The Composite Lateral Arm Free Flap: Vascular Relationship to Triceps Tendon and Muscle , 1992, Annals of plastic surgery.

[11]  M. Kŭmi,et al.  Late reconstruction of two total metacarpal bone defects using lengthening devices and a double-barrel osteocutaneous free parascapular flap. , 2000, Plastic and reconstructive surgery.

[12]  C. V. Penteado.  Venous Drainage of the Groin Flap , 1983, Plastic and reconstructive surgery.

[13]  Marko Godina.  Early microsurgical reconstruction of complex trauma of the extremities. , 1986 .

[14]  M. Kasdan,et al.  Reconstruction of the amputated finger tip with a triangular volar flap. A new surgical procedure. , 1970, The Journal of bone and joint surgery. American volume.

[15]  D. McGrouther,et al.  The degloved hand: immediate complete restoration of skin cover with a contralateral forearm free flap. , 1985, British journal of plastic surgery.

[16]  P. Squarzina,et al.  Dorsalis Pedis Flap with Vascularized Extensor Tendons for Dorsal Hand Reconstruction , 1993, Plastic and reconstructive surgery.

[17]  M. Beppu,et al.  The Lateral Upper Arm Flap: Anatomy and Clinical Applications , 1984, Annals of plastic surgery.

[18]  T. Fujii,et al.  A clinical and histologic comparison between free temporoparietal and scapular fascial flaps. , 1995, Plastic and reconstructive surgery.

[19]  R. Edlich,et al.  Debridement: an essential component of traumatic wound care. , 1978, American journal of surgery.

[20]  Cronin Td.  The cross finger flap: a new method of repair. , 1951 .

[21]  M. Earley.  The Second Dorsal Metacarpal Artery Neurovascular Island Flap , 1989, Journal of hand surgery.

[22]  W. Kutler.  A new method for finger tip amputation. , 1947, Journal of the American Medical Association.

[23]  G. Germann,et al.  The Reverse Pedicle Heterodigital Cross-Finger Island Flap , 1997, Journal of hand surgery.

[24]  J. Baudet,et al.  The Parascapular Flap: A New Cutaneous Microsurgical Free Flap , 1982, Plastic and reconstructive surgery.

[25]  G. Germann,et al.  Versatility and Reliability of Combined Flaps of the Subscapular System , 1999 .

[26]  A. D. Van den Abbeele,et al.  An Investigation of Lymphatic Function Following Free‐Tissue Transfer , 1997, Plastic and reconstructive surgery.

[27]  L. Scheker,et al.  Emergency free flaps to the upper extremity. , 1988, The Journal of hand surgery.

[28]  R. Wb,et al.  Soft tissue reconstruction. Coverage of hand injuries. , 1993 .

[29]  J. Small,et al.  The second dorsal metacarpal artery neurovascular island flap. , 1990, British journal of plastic surgery.

[30]  L. A. Koman,et al.  The Vascularized Cutaneous Scapular Flap , 1982, Plastic and reconstructive surgery.

[31]  B. Partecke,et al.  [Possibilities of preliminary treatment of infected soft tissue defects by vacuum sealing and PVA foam]. , 1998, Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V....