One stage reconstruction with flow-through anterolateral thigh neurocutaneous flap for patient with massive soft tissue defect of the hand.
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Date
2020
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ievads:
Augšējo ekstremitāšu augstas enerģijas traumas rezultējās ar plašu audu un daudzu anatomisku struktūru zudumu, nopietnu pacientu saslimstību un komplicētu ārstniecisko plānu. Lai atjaunotu pacienta funkcijas iespējas – brīvo audu transfers un vienetapa rekonstrukcija varētu uzlabot funkcionālo iznākumu un pacienta apmierināšanu.
Gadījuma apraksts:
45 gadu vecs vīrietis iestājas slimnīcā dēļ smagas traumas kreisajā rokā. Klīniskā eksaminācija paradīja plašu mīksto audu defektu kreisās plaukstas volarajā aspektā, pirkstu cīpslās, nervaudos un asinsvados. Pacientu nosūtīja uz neatliekamo operāciju. Trešais un ceturtais pirksts paradīja hipoperfūziju ar artērijas defektu, ka arī n.medianus defekts bija konstatēts no otrā līdz ceturtām pirkstam. Lai veiktu visu anatomisko struktūru rekonstrukciju vienlaicīgi, bija paņemts caurplūstošs priekšēji-laterāls augšstilba lēveris (angl. AnteroLateral Thigh flap – ALT flap), kas ir bāzēts uz a.circumflex femoris lateralis lejupejošā zara, kas parasti iet starp m.rectus femoris un m.vastus lateralis. Sensorā defekta dēļ papildus bija paņemts n.cutaneous femoris lateralis. Lejupejošā zara distālais gals bija disecēts lai atjaunotu asinsplūsmu uz trešo un ceturto pirkstu. Artēriju anastamozes bija veiktas gals-sanā manierē pie a.ulnaris, kamēr akompanējošās vēnas bija sašūtas gals-galā manierē. Nerva proksimālais gals bija piešūts pie n.medianus, bet tā distāla daļa bija sašķelta un piešūta pie otrā un trešā kopējā digitālā nerva galiem. Aktīva rehabilitācija bija uzsākta trešajā pēcoperācijas dienā un divu mēnēšu laikā pacients sasniedza gandrīz pilnu spēku un aktivitāšu apjomu.
Secinajums:
ALT lēveris dod dažādas opcijas masīvo defektu rekonstrukcijai vienā etapā bez papildus operāciju vajadzības un iespējamo atveseļošanās līdz preoperatīvā aktivitāšu līmeņa.
Kopsavilkums:
Rokas audu defektiem, kas saistīti ar lielu enerģijas traumu, ir izaicinoša ārstēšana. Šajā gadījumā vienetapa rekonstrukcija ar ALT neurokutāno lēveri bija pielietota lai atjaunotu daudzās anatomiskās struktūras, līdz ar to veicinot agrīno rehabilitāciju un funkcionalitātes atgūšanu.
Introduction: High energy trauma of the upper extremity results with major tissue and multiple anatomical structure loss, significant patient morbidity and challenging treatment plan. To restore patient’s functionality - free tissue transfer and one stage reconstruction could improve functional outcome and satisfaction. Case description: Forty-five-year-old patient admitted to the hospital due to severe trauma of left hand. Clinical examination showed massive soft tissue defect of the volar aspect of the palm, tendon, nerve and blood vessel injury of the fingers. The patient underwent urgent operation. Third and fourth finger showed hypoperfusion with artery defect, while n.medianus defect was detected for second to fourth finger. To reconstruct all anatomical structures simultaneously, flow through anterolateral thigh (ALT) flap was harvested, which is based on the descending branch of the lateral femoral circumflex artery with accompanying veins. Due to sensory defect n.cutaneous femoris lateralis was included. Distal part of descending artery branch was dissected for restoration of blood flow to the third and fourth finger. Artery anastomosis was done in end-to-side manner to a.ulnaris, while accompanying veins were sutured in end-to-end manner. Proximal end of the nerve was sutured to n.medianus, while distal part was split and sutured to the second and third common digital nerve ends. Active rehabilitation was started on the third post-operative day, and two months later the patient has returned almost full range of motion and strength. Conclusions: ALT flap provides versatile reconstruction options for multiple tissue defects in one stage with no need for additional surgeries with possible recovery to preoperative levels of activity. Summary: Treatment of high energy trauma induced tissue defects of the hand is challenging. In this case one-stage reconstruction using flow through ALT neurocutaneous flap was used for multiple anatomical structure repair, thus improving early rehabilitation and functionality.
Introduction: High energy trauma of the upper extremity results with major tissue and multiple anatomical structure loss, significant patient morbidity and challenging treatment plan. To restore patient’s functionality - free tissue transfer and one stage reconstruction could improve functional outcome and satisfaction. Case description: Forty-five-year-old patient admitted to the hospital due to severe trauma of left hand. Clinical examination showed massive soft tissue defect of the volar aspect of the palm, tendon, nerve and blood vessel injury of the fingers. The patient underwent urgent operation. Third and fourth finger showed hypoperfusion with artery defect, while n.medianus defect was detected for second to fourth finger. To reconstruct all anatomical structures simultaneously, flow through anterolateral thigh (ALT) flap was harvested, which is based on the descending branch of the lateral femoral circumflex artery with accompanying veins. Due to sensory defect n.cutaneous femoris lateralis was included. Distal part of descending artery branch was dissected for restoration of blood flow to the third and fourth finger. Artery anastomosis was done in end-to-side manner to a.ulnaris, while accompanying veins were sutured in end-to-end manner. Proximal end of the nerve was sutured to n.medianus, while distal part was split and sutured to the second and third common digital nerve ends. Active rehabilitation was started on the third post-operative day, and two months later the patient has returned almost full range of motion and strength. Conclusions: ALT flap provides versatile reconstruction options for multiple tissue defects in one stage with no need for additional surgeries with possible recovery to preoperative levels of activity. Summary: Treatment of high energy trauma induced tissue defects of the hand is challenging. In this case one-stage reconstruction using flow through ALT neurocutaneous flap was used for multiple anatomical structure repair, thus improving early rehabilitation and functionality.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Mikroķirurģija, priekšēji-laterāls augšstilba lēveris, Microsurgery, anterolateral thigh flap