Öz
Giriş: Başparmak pulpası el yaralanmalarının sık görüldüğü bir bölgedir ve yaralanma sonrası yapılan rekonstrüksiyonla kazanılan duyu el fonksiyonu için oldukça önemlidir. Çalışmamız başparmak pulpa defektinin rekonstrüksiyonunda kullanılan birinci dorsal metakarpal arter ada flebi olan Foucher’s flebinin kullanımı ve sonuçlarını tartışmak için yapıldı.
Yöntem: Çalışmamıza 2019 – 2021 yılları arasında hastanemize başvuran 14 başparmak pulp defektli 14 hasta dahil edildi. Hastalarımızın 12’si erkek, 2’si kadın, yaş ortalamaları ise 40,5±14,43 idi. 11 hastaya elektif cerrahi, 3 hastamıza da acil cerrahi uygulandı. Hastalarımız ameliyat sonrasındaki 1. hafta, 1. ay, 3. ay 6. ay ve 12. ay olarak takip edildi.
Sonuç: Ortalama flep boyutu 2,57 x 2,07 cm idi. Hastaların ortalama iki nokta ayrım duyarlılığı (s2-PD) 8,9 mm olarak ölçüldü ve bu sonuç gayet tatmin ediciydi. Bir hastamızda marjinal nekroz, bir hastamızda epidermoliz ve bir hastamızda venöz konjesyon gözlemledik fakat uyguladığımız fleplerin hiçbirinde flep kaybı yaşamadık.
Tartışma: Foucher’s flebi başparmak pulp defekti olan hastalarda dokunma hissini sağlayabilen başarılı bir yumuşak doku rekonstrüksiyon tekniğidir. Donör sahada minimal morbidite oluşturarak pulp defekti dokunma hissi elde edilerek rekonstrükte edilmektedir. Çalışmamızda da minimum komplikasyon ve güvenilir bir rekonstrüksiyon tekniği olduğunu göstermiş olduk.
Anahtar Kelimeler
Foucher’s flep Başparmak pulp defekti Dorsal metakarpal arter Ada flebi
Kaynakça
- 1. Delikonstantinou IP, Gravvanis, AI, Dimitriou V, Zogogiannis I, Douma A, Tsoutsos DA. Foucher First Dorsal Metacarpal Artery Flap Versus Littler Heterodigital Neurovascular Flap in Resurfacing Thumb Pulp Loss Defects. Ann Plast Surg. 2011; 67(2):119-22.
- 2. Muyldermans T, Hierner R. First dorsal metacarpal artery flap for thumb reconstruction: a retrospective clinical study. Strategies Trauma Limb Reconstr. 2009;4(1):27-33.
- 3. Xarchas KC, Tilkeridis KE, Pelekas SI, Kazakos KJ, Kakagia DD, Verettas DA. Littler's flap revisited: An anatomic study, literature review, and clinical experience in the reconstruction of large thumb pulp defects. Med Sci Monit. 2008;14(11):CR 568–73.
- 4. Guelmi K, Barbato B, Maladry D, Mitz V, Lemerle JP. Reconstruction of digital pulp by pulp tissue transfer of the toe. Apropos of 15 cases. Rev Chir Orthop Reparatrice Appar Mot. 1996;82(5): 446–52.
- 5. Woon CY, Lee JY, Teoh LC. Resurfacing hemipulp losses of the thumb: The cross finger flap revisited: Indications, technical refinements, outcomes and long-term neurosensory recovery. Ann Plast Surg. 2008;61(4): 385–91.
- 6. Chang SC, Chen SL, Chen TM, Chuang CJ, Cheng TY, Wang HJ. Sensate first dorsal metacarpal artery flap for resurfacing extensive pulp defects of the thumb. Ann Plast Surg. 2004;53(5): 449–54.
- 7. Sherif MM. First dorsal metacarpal artery flap in hand reconstruction. I. Anatomical study. J Hand Surg Am. 1994;19(1): 26–31.
- 8. El-Khatib HA. Clinical experiences with extended first dorsal metacarpal artery island flap for thumb reconstruction. J Hand Surge Am. 1998;23: 647–52.
- 9. Foucher G, Braun JB. A new island flap transfer from the dorsum of the index to the thumb. Plast Reconstr Surg. 1979;63: 344–49.
- 10. Earley MJ. The arterial supply of the thumb, first web and index finger and its surgical application. J Hand Surg Br. 1986;11(2):163–74.
- 11. Ghoraba SM, Mahmoud WH. Outcome of Thumb Reconstruction Using the First Dorsal Metacarpal Artery Island Flap. World J Plast Surg. 2018 May;7(2):151-158.
- 12. Luttenberger M, Taqatqeh F, Dragu A, Bota O. Thumb Reconstruction after Severe Trauma Using the Masquelet Technique and the Foucher Neurovascular Flap. Plast Reconstr Surg Glob Open. 2020;8(9): e3097.
- 13. Ghelani N, Shah S, Kaushal A, Ponkiya H. First Dorsal Metacarpal Artery (FDMA) flap: A reliable choice for thumb defects. BJKines-NJBAS;11(2):2019.
- 14. Ray EC, Sherman R, Stevanovic M. Immediate reconstruction of a nonreplantable thumb amputation by great toe transfer. Plast Reconstr Surg. 2009;123(1):259-67.
- 15. Dogan F, Coruh A. Novel biogeometric designs of first dorsal metacarpal artery flap in hand reconstruction. J Burn Care Res. 2014;35(6): 399-405.
- 16. Al Lahham S, Ahmed MB, Aljassem G, Sada R, Alyazji ZTN, Thomas J. A Modification to Enhance the Survival of the Island FDMA Flap by Adding a Skin Bridge. Plast Reconstr Surg Glob Open. 2021;9(2): e3434.
- 17. Kola N. Thumb Reconstruction Using Foucher's Flap. Open Access Maced J Med Sci. 2016;4(1):70-3.
- 18. Couceiro J, Sanmartín M. The Holevich flap revisited: a comparison with the Foucher flap, case series. Hand Surg. 2014;19(3):469-74.
- 19. Zhang X, Shao X, Ren C, Zhang Z, Wen S, Sun J. Reconstruction of thumb pulp defects using a modified kite flap, J Hand Surg Am. 2011;36(10):1597– 603.
Öz
Background: Thumb pulp is a common site for hand injuries and the sensory function gained with its reconstruction is very important for hand function. We aimed the focusing in Foucher’s flap of the first dorsal metacarpal artery for coverage of thumb pulp defects.
Methods: Our study was done over a period of two years, between 2019 and 2021 and involved 14 consecutive cases of thumb pulp defects treated in our institution. The patients included 12 males and 2 female, mean age of 40,5±14,43 years. Three elective and eleven emergency cases were operated in the study. We observed the patients for a period as following first week, 1 st. Month, 3. Month, 6 and 12 month.
Results: The mean used flap was 2,57x2,07 cm. All the patients had good fine touch and the mean two-point discrimination (s2-PD) was 8,9 mm, which was satisfactory. No flap loss occurred in any patient; one patient distal margin necrosis, one patient epidermolysis and one patient venous congestion were observed.
Conclusion: Foucher’s flap for thumb pulp defects is successful flap tecnique for sensation reconstruction. It replaces the soft tissue loss at the thumb pulp with minimal donor site morbidity and with good return of thumb pulp sensation. Our experience showed that Foucher’s flap is reliable option and has minimal complications.
Anahtar Kelimeler
Foucher’s flap thumb pulp defect dorsal metacarpal artery island flap
Kaynakça
- 1. Delikonstantinou IP, Gravvanis, AI, Dimitriou V, Zogogiannis I, Douma A, Tsoutsos DA. Foucher First Dorsal Metacarpal Artery Flap Versus Littler Heterodigital Neurovascular Flap in Resurfacing Thumb Pulp Loss Defects. Ann Plast Surg. 2011; 67(2):119-22.
- 2. Muyldermans T, Hierner R. First dorsal metacarpal artery flap for thumb reconstruction: a retrospective clinical study. Strategies Trauma Limb Reconstr. 2009;4(1):27-33.
- 3. Xarchas KC, Tilkeridis KE, Pelekas SI, Kazakos KJ, Kakagia DD, Verettas DA. Littler's flap revisited: An anatomic study, literature review, and clinical experience in the reconstruction of large thumb pulp defects. Med Sci Monit. 2008;14(11):CR 568–73.
- 4. Guelmi K, Barbato B, Maladry D, Mitz V, Lemerle JP. Reconstruction of digital pulp by pulp tissue transfer of the toe. Apropos of 15 cases. Rev Chir Orthop Reparatrice Appar Mot. 1996;82(5): 446–52.
- 5. Woon CY, Lee JY, Teoh LC. Resurfacing hemipulp losses of the thumb: The cross finger flap revisited: Indications, technical refinements, outcomes and long-term neurosensory recovery. Ann Plast Surg. 2008;61(4): 385–91.
- 6. Chang SC, Chen SL, Chen TM, Chuang CJ, Cheng TY, Wang HJ. Sensate first dorsal metacarpal artery flap for resurfacing extensive pulp defects of the thumb. Ann Plast Surg. 2004;53(5): 449–54.
- 7. Sherif MM. First dorsal metacarpal artery flap in hand reconstruction. I. Anatomical study. J Hand Surg Am. 1994;19(1): 26–31.
- 8. El-Khatib HA. Clinical experiences with extended first dorsal metacarpal artery island flap for thumb reconstruction. J Hand Surge Am. 1998;23: 647–52.
- 9. Foucher G, Braun JB. A new island flap transfer from the dorsum of the index to the thumb. Plast Reconstr Surg. 1979;63: 344–49.
- 10. Earley MJ. The arterial supply of the thumb, first web and index finger and its surgical application. J Hand Surg Br. 1986;11(2):163–74.
- 11. Ghoraba SM, Mahmoud WH. Outcome of Thumb Reconstruction Using the First Dorsal Metacarpal Artery Island Flap. World J Plast Surg. 2018 May;7(2):151-158.
- 12. Luttenberger M, Taqatqeh F, Dragu A, Bota O. Thumb Reconstruction after Severe Trauma Using the Masquelet Technique and the Foucher Neurovascular Flap. Plast Reconstr Surg Glob Open. 2020;8(9): e3097.
- 13. Ghelani N, Shah S, Kaushal A, Ponkiya H. First Dorsal Metacarpal Artery (FDMA) flap: A reliable choice for thumb defects. BJKines-NJBAS;11(2):2019.
- 14. Ray EC, Sherman R, Stevanovic M. Immediate reconstruction of a nonreplantable thumb amputation by great toe transfer. Plast Reconstr Surg. 2009;123(1):259-67.
- 15. Dogan F, Coruh A. Novel biogeometric designs of first dorsal metacarpal artery flap in hand reconstruction. J Burn Care Res. 2014;35(6): 399-405.
- 16. Al Lahham S, Ahmed MB, Aljassem G, Sada R, Alyazji ZTN, Thomas J. A Modification to Enhance the Survival of the Island FDMA Flap by Adding a Skin Bridge. Plast Reconstr Surg Glob Open. 2021;9(2): e3434.
- 17. Kola N. Thumb Reconstruction Using Foucher's Flap. Open Access Maced J Med Sci. 2016;4(1):70-3.
- 18. Couceiro J, Sanmartín M. The Holevich flap revisited: a comparison with the Foucher flap, case series. Hand Surg. 2014;19(3):469-74.
- 19. Zhang X, Shao X, Ren C, Zhang Z, Wen S, Sun J. Reconstruction of thumb pulp defects using a modified kite flap, J Hand Surg Am. 2011;36(10):1597– 603.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Nisan 2022 |
| Gönderilme Tarihi | 6 Şubat 2022 |
| Kabul Tarihi | 28 Mart 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 19 Sayı: 1 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty