|2009 Annual Meeting Abstracts
Local and Free Fascial Flap Transfers to the Hand: A Single Microsurgeon's 10-Year Experience
Matthew J. Carty, M.D.1, Amir Taghinia, M.D.2, Joseph Upton, M.D.2.
1Brigham & Women's Hospital, Boston, MA, USA, 2Children's Hospital Boston, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Reconstruction of soft tissue defects of the hand remains a daunting surgical problem. The requirements for thin and pliable coverage with a reliable vascular supply, potential for sensibility and provision of a proper gliding surface are not readily supplied by standard skin grafts or conventional muscle, myocutaneous or fasciocutaneous free tissue transfers. However, fascial flaps - both pedicled and free - represent an excellent option for the reconstruction of these complicated defects.
A retrospective review of all fascial flap reconstructive procedures to the hand undertaken by a single microsurgeon was performed for operations occurring between 1998 and 2008. Both pedicled and microvascular free tissue transfer-enabled procedures were included in both pediatric and adult patient populations. Data was culled from a combination of patient charts, hospital records, radiographic studies and clinical photographs.
Sixty consecutive fascial flap reconstructive procedures to the hand were analyzed in sixty patients from the defined 10-year period. The most common pathological process necessitating hand soft tissue reconstruction was trauma (n=30, 50%), followed by late contracture (n=10, 17%), thermal injury (n=6, 10%), congenital abnormalities (n=5, 8%), tumor (n=5, 8%) and other (n=4, 7%). The most commonly performed flap was the temporoparietal fascial flap (n=31, 52%), followed by the radial forearm fascial flap (n=14, 23%), first dorsal metacarpal artery fascial flap (n=10, 17%) and the tensor fascia lata flap (n=5, 8%). More than half of the reconstructive procedures were performed as free tissue transfers (n=36, 60%), while the remainder were pedicled flaps (n=24, 40%). Perioperative complications were relatively minor; no flap losses were recorded. All cases studied demonstrated excellent long-term coverage with no evidence of underlying tendon adhesion or contracture.
Fascial flaps represent an excellent option for coverage of soft tissue defects of the hand that are not amenable to reconstruction with skin grafting alone. In providing a thin and pliable substrate with reliable axial vessels, the potential for sensibility, excellent gliding surfaces and the option for subsequent coverage with either glabrous or non-glabrous skin, they are superior to more conventional flaps. In particular, these flaps should be the reconstructive option of choice for localized defects of the hand with denuded tendons or exposed joints.