Dorsal Hand Reconstruction; Comparative Study Between Regional and Distant Pedicled Flaps Following Traumatic Injuries in Developing Countries
Keywords:
Hand dorsum trauma, Post traumatic injuries, Tendon injury, Dorsal hand reconstruction, surgical flapsAbstract
Background: Hand is a complex anatomical and functional structure in human body that's why special attention is provided to approach different hand injuries to achieve a good aesthetic and functional outcome. Non microsurgical regional or distant flap options tend to be more robust than free tissue transfer especially in developing countries, but require careful planning to choose the most appropriate coverage while being aware of potential complications and future management options. Dorsal hand injuries resulting from a traumatic event are associated with other systematic injuries that preclude lengthy procedures and the lack of microsurgical expertise make the non-microsurgical options from the reconstructive ladder more suitable for those patients.
Patients and methods: This study was conducted on 20 patients presented with full thickness dorsal hand injuries and post traumatic soft tissue defects. Primary survey was done to exclude any life threatening condition. The patients were assorted into 2 groups according to their general condition, comorbidities, donor site morbidity and reliability of the flap coverage technique. Group A included patients who underwent regional pedicled flap and group B included patients who underwent distant pedicled flap. Vigorous irrigation, debridement, hardware fixation, tendon repair and finally coverage were done for all patients. Postoperatively aggressive rehabilitation in the form of relative motion extension program (RME) was done. Results: The study population included 15 males (75%) and 5 females (25%). The mean age of patients was 30.4 years. The mean size of the defects was 67.6 cm2. Bone fracture was present in 17 patients (85%). Postoperative complications percentage was (20%). The functional outcome improved after surgical repair of the injured tendons and by rehabilitation programs.
Conclusion: Distant pedicled flap option shows comparable results to regional pedicled flap option in dorsal hand injuries reconstruction in countries with limited resources. The functional outcome can be improved by proper extensor tendon repair, reconstruction and aggressive postoperative rehabilitation programs
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