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The composite groin fascial free flap
S F Jeng1, F C Wei, M S Noordhoff
1Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung Medical College, Taiwan, Republic of China.
Annals of Plastic Surgery
|December 1, 1995
Summary
This study presents a successful one-stage surgical technique using free composite groin flaps for hand and foot reconstruction. The method minimizes tendon adhesions, improving outcomes for patients with extensive tissue loss.
Area of Science:
- Reconstructive surgery
- Microsurgery
- Orthopedic surgery
Background:
- Extensive soft tissue loss on the dorsum of the hand and foot, involving extensor tendons and bone/joint exposure, presents significant reconstructive challenges.
- Traditional methods may lead to adhesions and require secondary procedures, impacting functional recovery and cosmesis.
Purpose of the Study:
- To evaluate the efficacy of a novel free composite flap technique for reconstructing defects of the dorsum of the hand and foot.
- To assess the potential of this technique to reduce tendon adhesions and improve functional outcomes in a single-stage procedure.
Main Methods:
- Seven patients with extensive dorsal hand/foot defects underwent reconstruction using free composite flaps harvested from the groin area.
- The flap incorporated a groin skin flap based on superficial circumflex iliac vessels and a well-vascularized external oblique aponeurosis.
- Membrane interposition was used between the tendon and bone to prevent scarring and adhesions.
Main Results:
- All seven free composite free-tissue transfers were technically successful, providing both skin coverage and a gliding surface for tendons.
- The procedure resulted in a single, one-stage reconstruction.
- Patients experienced fewer adhesions of reconstructed tendons, negating the need for secondary tenolysis, and demonstrated good cosmetic results with minimal donor site morbidity.
Conclusions:
- Free composite flaps from the groin, incorporating external oblique aponeurosis, are a highly effective one-stage solution for extensive dorsal hand and foot defects.
- This technique significantly reduces tendon adhesions, leading to improved functional recovery and aesthetic outcomes.
- The procedure offers a reliable reconstructive option with minimal donor site morbidity.