Abstract
Circular saw injuries of the hand commonly include tendon laceration, fractures, and neurovascular compromise. In addition, they are often accompanied by a significant loss of soft tissue that leaves the injured structures exposed.
While even minor trauma to the hand can limit its function, extended trauma often renders the hand completely dysfunctional. Since the interconnected anatomy of the hand is the basis for its flawless function, the functional reconstruction following complex hand injuries displays a severe challenge to the reconstructive surgeon. The accompanying tissue loss makes these cases even more challenging.
This case illustrates a four-stage reconstruction of an accidental circular saw injury of the right hand with injuries of the neurovascular system, the flexor tendons, and a significant loss of soft tissue in three of the fingers, leaving all of the injured structures exposed. The first stage involved thorough debridement and damage control. To initially cover the vital structures, a temporary VAC®-therapy was chosen (VAC®, KCI, San Antonio, TX, USA).
The second stage was performed 72 h after the initial injury and involved the soft tissue coverage with an extracutaneous free SCIP flap as well as the reconstruction of the compromised structures, which could either be sutured directly or, in case of the ruptured deep flexor tendon of the index finger, using a Palmaris longus interpositional graft and osseous refixation. The long segmental defect of the radial finger nerve of the ring finger was reconstructed in the same session, using an ipsilateral, lateral antebrachial cutaneous nerve interpositional graft. Three weeks later, the third stage included dividing the skin pedicle of the free flap, while another 8 weeks later a flap thinning procedure was performed as the fourth and final step.
The recovery time of all four stages was uneventful, with an acceptable aesthetic and functional result.
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References
Brenner P, Lassner F, Becker M, et al. Timing of free microsurgical tissue transfer for the acute phase of hand injuries. Scand J Plast Reconstr Surg Hand Surg. 1997;31(2):165–70.
Chen SH, Wei FC, Chen HC, et al. Emergency free-flap transfer for reconstruction of acute complex extremity wounds. Past Reconstr Surg. 1992;89(5):882–8.
Choi DH, Goh T, Cho JY, et al. Thin superficial circumflex iliac artery perforator flap and supermicrosurgery technique for face reconstruction. J Craniofac Surg. 2014;25:2130–3.
Fuse Y, Yoshimatsu H, Yamamoto T. Lateral approach to the deep branch of the superficial circumflex iliac artery harvesting a SCIP flap. Microsurgery. 2018;38(5):589–90.
Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg. 1986;78(3):285–92.
Goh TL, Park SW, Cho JY, et al. The search for the ideal thin skin flap: superficial circumflex iliac artery perforator flap – a review of 210 cases. Plast Reconstr Surg. 2015;135(2):592–601.
Harrison BL, Lakhiani C, Lee MR, Saint-Cyr M. Timing of traumatic upper extremity free flap reconstruction: a systematic review and progress report. Plast Reconstr Surg. 2013;132(3):591–6.
Li X, Cui J, Maharajan S, et al. Neo-digit functional reconstruction of mutilating hand injury using transplantation of multiple composite tissue flaps. Medicine (Baltimore). 2016;95(27):e4179.
Neumeister MW, Brown RE. Mutilating hand injuries: principles and management. Hand Clin. 2003;19(1):1–15.
Neumeister M, Hegge T, Amalfi A, et al. The reconstruction of the mutilated hand. Semin Plast Surg. 2010;24(1):77–102.
Ng ZY, Askari M, Chim H. Approach to complex upper extremity injury: an algorithm. Semin Plast Surg. 2015;29(1):5–9.
Rehim SA, Chung KC. Local flaps of the hand. Hand Clin. 2014;30(2):137–51.
Scheker LR, Ahmed O. Radical debridement, free flap coverage, and immediate reconstruction of the upper extremity. Hand Clin. 2007;23(1):23–6.
Tashiro K, Harima M, Kato M. Preoperative color Doppler ultrasound assessment in planning of SCIP flaps. J Plast Reconstr Aesthetic Surg. 2015;68(7):979–83.
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Jandali, Z., Merwart, B., Jiga, L. (2020). Extracutaneous Free Triple Split SCIP Flap for Simultaneous Reconstruction of Multiple Soft Tissue Defects of the Fingers. In: Clinical Scenarios in Reconstructive Microsurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-94191-2_51-1
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DOI: https://doi.org/10.1007/978-3-319-94191-2_51-1
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