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Summary
A novel flap technique using loose connective tissue can reconstruct gliding mechanisms and enable staged tendon and nerve repair at the wrist. This surgical approach offers a viable solution for complex hand injuries.
Area of Science:
- Plastic Surgery
- Hand Surgery
- Reconstructive Surgery
Background:
- Flexor tendon adhesions at the wrist impede hand function.
- Tendon and nerve reconstruction requires specialized techniques for optimal gliding.
- Local and free flaps offer reconstructive options for complex defects.
Observation:
- A specific flap of loose connective tissue, based on the thoracodorsal vessels, can be harvested.
- This flap is situated between the latissimus dorsi and serratus lateralis muscles.
- The flap can be utilized as either a local or a free flap transfer.
Findings:
- The described flap successfully reconstructed the gliding mechanism in wrist-level flexor tendon adhesions.
- It also facilitated staged tendon and nerve reconstruction at the wrist.
- Five hands in four patients were treated, with one case resulting in failure.
Implications:
- This flap provides a valuable option for restoring gliding function in adhered tendons.
- It offers a versatile solution for complex, multi-stage reconstructions of tendons and nerves in the hand.
- Further refinement and application of this flap technique could improve outcomes in hand surgery.