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Vascularized Composite Hand Allograft Procurement and Preparation for Distal and Proximal Forearm Allotransplantation: A Stepwise Approach
Published on: May 23, 2025
[Abductor digiti minimi muscle flap for defect coverage of the hand]
F Stang1, F Siemers, T von Wild
1Klinik für Plastische Chirurgie, Handchirurgie, Intensiveinheit für Schwerbrandverletzte, Universitätsklinik Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. felix.stang@gmx.de
Objective:
Defect coverage of the ulnar aspect of the hand, wrist and hypothenar with an abductor digiti minimi muscle flap and split skin graft.
Indications:
Soft tissue defects of the ulnar aspect of the hand, wrist and hypothenar. Osteomyelitis of the fifth metacarpal bone.
Contraindications:
Large defects > 3 × 5 cm, complex hand trauma, injuries of the ulnar artery or within the area of the pedicle.
Surgical Technique:
Marking of the flap's rotational radius, using the pisiform bone as the center point. Ulnar skin incision and exposure and detachment of the distal flap pole, which is located at the level of the metacarpophalangeal (MCP) joint. Dissection of the abductor digiti minimi muscle flap up to the vascular pedicle in the area of the pisiform bone. Transposition and fixation of the flap onto the defect after opening of the tourniquet. Coverage of the muscle flap with a split skin graft. Wound closure of the donor side.
Postoperative Management:
Palmar cast splinting in intrinsic-plus position for 10 days physiotherapy. Scar care and compression glove for 3 months.
Results:
In total, 9 patients showed good results with a reliable defect coverage due to a constant anatomy and easy preparation.
