Procedures of Soft Tissues Reconstructions of the Hand Preceding Toe-to-Hand Transfers
Extensive defects, damage and resulting scarring of tissues frequently accompany amputation of fingers. Better functional result of rebuilt thumb using toe can be achieved when soft tissue reconstruction is performed in first stage.
The aim of the study was to present current methods of soft tissue reconstruction and evaluation of their results in patients after thumb rebuilt with toe.
Material and methods. In 18 males (aged 15-45, mean 25) of 75 patients after hand trauma and thumb reconstruction by toe-to-hand transfer, rebuilding of soft tissues of the hand was also required. This operation, as the first stage of reconstruction, was performed in 16 cases and in 2 cases both stages (soft tissue and thumb reconstructions) were conducted simultaneously during one procedure. Various methods of soft tissue reconstruction on hand and thumb were used. Between 1986 and 1996 pedicled groin flap was most frequently performed (8 cases). After 2000 adipocutaneous flap based on perforators of radial artery located in distal forearm was a dominating method of soft tissues reconstruction (5 cases). Thumb was rebuilt with the second toe most frequently (13 cases).
Results. Despite observed complications in flap healing, sufficient coverage was achieved to conduct toe-to-thumb transfer in all cases. Osteocutaneous groin flap did not bring expected advantages in bone reconstruction within the first ray of the hand. The time interval from injury to soft tissue reconstruction (0-27 months) and the time from soft tissue reconstruction to thumb restoration (0-12 years) had no influence on final result of treatment.
Conclusions. Pedicled adipocutaneous groin flap is still one of the basic methods of treating extensive posttraumatic defects of the hand soft tissues. In cases of minor tissue loss causing adduction contracture of the first metacarpal bone, particularly after explosive injuries, distally pedicled adipocutaneous flap supplied by radial artery perforators is a simple and effective therapeutic option. This method has two significant advantages in comparison to groin flap: fixation of the hand in uncomfortable position is not required and reconstruction can be completed in one-stage. Further recognition and understanding of the flap tissues healing process require careful clinical observations.