DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20181779

Chinese forearm flap technique in thumb injury: a case report

Zainarda ., A. A. Gde Yuda Asmara, Putu Suehandika Caksana

Abstract


Hand injuries which involve substantial skin loss require immediate soft tissue cover to achieve early wound closure and to minimize wound infection and scarring. In 1978, Dr. Yang Guofan and Dr. Chen Baoqui described a flap from the forearm based on the radial artery or Chinese Forearm Flap. A 30-year-old male was admitted to the emergency room because of crush injury. From physical examination we found crush injuries of left hand followed with open wound between 1st and 2nd finger at dorsal and palmar side with muscle, tendon, and bone exposed, with open dislocation left 1st carpometacarpal joint, open fracture dislocation left 1st metacarpophalank joint, open fracture Left Base 2nd, 4th metacarpal, open dislocation 3rd base metacarpal, open fracture left trapezoid, open left trapezium. Soft tissue injuries of the hand which require flap cover pose a problem mainly because of the apparent lack of availability of local tissue. Wound healing problems can result in an impaired functional outcome. For complication, initially, sensory disturbances can be found in 17-75% but decrease during the next months. This radial forearm flap method of post-traumatic thumb reconstruction nowadays doesn’t require expert microsurgical knowledge, which is indispensable in case of replantation or revascularization of the amputated thumb. Correct planning and elevation presupposed the flap success rates average at least 90% with no relevant limitations in strength, motion and hemodynamics in the forearm or hand and non-disturbing sensory and cosmetic outcome at the donor site.


Keywords


Forearm flap, Hand injury, Skin graft, Thumb reconstruction

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References


Yang G. Forearm free skin flap transplantation; report of 56 cases. National Medical Journal of China. Med. J. China. 1981;61:139.

Song. The forearm flaps. Clinics in Plastic Surgery 1982;9:21-26.

Soutar DS, Scheker LR, Tanner NSB, McGregor IA. The radial forearm flap: a versatile method for intra-oral reconstruction. British Journal of Plastic Surgery. 1983;36:1-8.

Stock W, Miihlabauer W, Biemer E. Der neurovaskulare Unterarm-Insel-Lappen. Zeitschrif ftir Plastische Chirurgie. 1981;5:158.

Biemer E, Stock W. Total thumb reconstruction: a one stage reconstruction using an osteo-cutaneous forearm flap. British Journal of Plastic Surgery. 1983;36:52.

Lister GD, Mcgregor IA, Jackson IT. Groin flap in hand injuries. Injury. 1973;4:229.

McGregor AD. The free radial forearm flap: The management of the secondary defect. Br J Plast Surg. 1987;40(1):83.

Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38(6):553-62.

Meland NB, Maki S, Chao EY, Rademaker B. The radial forearm flap: a biomechanical study of donor-site morbidity utilizing sheep tibia. Plast Reconstr Surg. 1992;90(5):763-73.

Partecke BD, Buck-Gramcko D. Free forearm flap for reconstruction of soft tissue defect concurrent with improved peripheral circulation. J Reconstr Microchir. 1984;1(1):1-6.

Anthony JP, Singer MI, Deschler DG. Dougherty ET, Reed CG, Kaplan MJ. Long-term functional results after pharyngoesophageal reconstruction with the radial forearm free flap. Am J Surg. 1994;168(5):441-5.

Ciuman R, Dost P. The forearm flap - indications, appropriate selection, complication, and functional outcome. Available at: https://pdfs.semanticscholar.org/b87f/bf3c35eada74cc8f8e18f1f9055466fec8dc.pdf. Accessed 20 January 2018.

Richardson D, Fisher SE, Vaughan ED, Brown JS. Radial forearm flap donor-site complications and morbidity: a prospective study. Plast Reconstr Surg. 1997;99(1):109-15.

Lovie MJ, Duncan GM, Glasson DW. The ulnar artery forearm flap. Br J Plast Surg. 1984;37(4):486-92.

Avery CM, Pereira J, Brown AE. Suprafascial dissection of the radial forearm flap and donor site morbidity. Int J Oral Maxillofac Surg. 2001;30(1):42-8.

Hülsbergen-Krüger S, Müller K, Partecke BD. Donor site defect after removal of free and pedicled forearm flaps: functional and cosmetic results. (German). Handchir Mikrochir Plast Chir. 1996;28:82(2):70-5.

Lutz BS, Chang SCN, Chuang SS, Wei FC. Supra-fascial elevated free forearm flap indications, surgical technique and follow-up examination of the donor site defect. (German). Handchir Mikrochir Plast Chir. 1999;31(1):10-4.

Chang SC, Miller, G, Halbert CF, Yang KH, Chao WC, Wei FC. Limiting donor site morbidity by suprafascial dissection of the radial forearm flap. Microsurgery. 1996;17(3):136-40.

Elliot D, Bardsley AF, Batchelor AG, Soutar DS. Direct closure of the radial forearm flap donor defect. Br J Plast Surg. 1996;41(4):354-7.

Hallock GG. Refinement of the radial forearm flap donor site using skin expansion. Plast Reconstr Surg. 1988;81(1):21-5.

Bootz F, Becker D, Fliesek J. Functional results and survival of tumor patients after reconstruction of the mouth cavity and oropharynx using a microvascular radial forearm flap. (German). HNO. 1993;41(8):542-52.

Coleman SS, Anson BJ. Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynec Obstet. 1961;113:409-24.

Jaschintski SN. Morphologie, Topography of the Arch volaris sublimus, profundus of man. (German). Anat Hefte. 1897;7:163-88.

McCormack L, Cauldwell EW, Anson BJ. Brachial and antebrachial arterial patterns. Surg Gynec Obstet. 1953;96(1):43-54.

Otsuka T, Terauchi M. An anomaly of the radial artery-relevance for the forearm flap. Br J Plast Surg. 1991;44(5):390-1.

Small JO, Millar R. The radial forearm flap: an anomaly of the radial artery. Br J Plast Surg. 1985;38(4):501.

Saski K, Nozaki M, Aiba H, Isono N. A rare variant of the radial artery: clinical considerations in raising a radial forearm flap. Br J Plast Surg. 1999;53(5):445-7.

Becker C, Gilbert A. The ulnar flap. (German). Handchir Mikrochir Plast Chir. 1988;20(4):180-3.

Boutros S, Yuksel E, Weinfeld AB, Alford EL, Netscher DT. Neural anatomy of the radial forearm flap. Ann Plast Surg. 2000;44(4):375-80.