Purpose
To review our outcomes of transferring vascularized free adipofascial flaps used to
change the local tissue conditions at the time of tenolysis in adhesion-prone beds.
Methods
Eleven free adipofascial flaps were transplanted in 10 patients after tenolysis on
the forearm (3 cases), the dorsum of the hand (5 cases), or the dorsum of the proximal
phalanx (3 cases). All recipient areas had badly scarred beds, 7 of which had previously
failed tenolyses. In addition to tenolysis (10) or the insertion of bridging tendon
grafts (1), arthrolysis of several involved joints and bone fixation for nonunion
(3 cases) were carried out simultaneously. The adipofascial flap was then wrapped
around the tendons or interposed between the scarred tissue and the freed tendons.
In 8 cases, the flap was the lateral arm adipofascial flap, whereas adipose flaps
from the toes were used for the fingers.
Results
All flaps survived without vascular crisis. In all cases, total active motion was
similar to the passive motion obtained at surgery. Average Disabilities of the Arm,
Shoulder, and Hand score improved from 69 to 10, and average Patient-Rated Wrist Hand
Evaluation score improved from 65 to 9. Secondary surgery was needed to reduce the
bulk of the flap in 3 patients. One patient required an additional procedure to obtain
an optimum result.
Conclusions
Free adipofascial flaps provided satisfying results in this group of patients. The
flaps should be considered when the bed is scarred or after a failed tenolysis.
Type of study/level of evidence
Therapeutic IV.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Double-layered free temporal fascia flap as a two-layered tendon-gliding surface.Plast Reconstr Surg. 1991; 88: 707-712
- Use of the double-layered free temporal fascia flap for upper extremity coverage.J Hand Surg Am. 1994; 19: 864-870
- The sandwich temporoparietal free fascial flap for tendon gliding.Plast Reconstr Surg. 2001; 108: 1639-1645
- Primary extensor tendon reconstruction in dorsal hand defects requiring free flaps.J Hand Surg Br. 1993; 18: 568-575
- Tubed radial fascial flap and reconstruction of the flexor apparatus in the forearm.J Hand Surg Am. 1993; 18: 959-962
- Experience with the temporoparietal fascial free flap.Plast Reconstr Surg. 1985; 76: 177-188
- Fascial flap reconstruction of the hand: a single surgeon's 30-year experience.Plast Reconstr Surg. 2010; 125: 953-962
- The lateral arm fascial free flap: its anatomy and use in reconstruction.Plast Reconstr Surg. 1990; 86: 1138-1145
- The use of the lateral arm flap in upper limb surgery.J Hand Surg Am. 1991; 16: 598-604
- Free vascularized fibular grafts have a high union rate in atrophic nonunions.Clin Orthop Relat Res. 2004; 419: 38-45
- Vascularized bone graft from the supracondylar region of the femur.Microsurgery. 2009; 29: 379-384
- Biology of chronic radiation effect on tissues and wound healing.Clin Plast Surg. 1993; 20: 435-453
- Limb salvage in the patient with severe peripheral vascular disease: the role of microsurgical free-tissue transfer.Plast Reconstr Surg. 1987; 79: 389-395
- Circumferential wrapping of a flap around a scarred peripheral nerve for salvage of end-stage traction neuritis.J Hand Surg Am. 1997; 22: 527-535
- The microvacuolar system: how connective tissue sliding works.J Hand Surg Eur Vol. 2010; 35: 614-622
- Seprafilm interposition for preventing adhesion formation after tenolysis: an experimental study on the chicken flexor tendons.J Surg Res. 2003; 113: 195-200
- Efficacy of ADCON-T/N after primary flexor tendon repair in Zone II: a controlled clinical trial.J Hand Surg Br. 2003; 28: 113-115
- Efficiency of Hyaloglide in the prevention of the recurrence of adhesions after tenolysis of flexor tendons in zone II: a randomized, controlled, multicentre clinical trial.J Hand Surg Eur Vol. 2010; 35: 130-138
- Endoscopic harvest of temporoparietal fascial free flaps for coverage of hand wounds.J Hand Surg Am. 2002; 27: 525-533
- Omentum as gliding material after extensive forearm tenolysis.Br J Plast Surg. 1993; 46: 590-593
- “Angiosome theory.”.Br J Plast Surg. 1992; 45: 327-328
- Super-thinned iliac flap for major defects on the elbow and wrist flexion creases.J Hand Surg Am. 2008; 33: 1899-1904
Article info
Publication history
Accepted:
November 18,
2013
Received:
August 29,
2013
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
