ARTICLE IN PRESS

FLAPS IN HAND RECONSTRUCTION 59

reconstruction with a one stage operation, they alwaysneed a wide dissection, which may lead to volar scarring.The majority of these problems can be avoided with theuse of the dorsal island homodigital flap. After debride-ment of the recipient area the length and width of the skindefect is measured and a flap is raised by making anincision across the dorsum of the digit 4 to 5mm proximalto the eponychium between the two midlateral lines. It isbased on the side of the proximal edge of the obliquity ofthe amputation stump and is islanded on a subcutaneoustissue pedicle that includes a dorsal artery and a nervebranch. From October 2005 to October 2006 the dorsalisland homodigital flap was used in 12 patients and we arepresenting our experience in the use of this flap.

10.1016/j.jhse.2007.02.159

A-0330

14.4 THE DIGITO-METACARPAL DORSAL FLAP: A

USEFUL DORSAL HAND FLAP FOR COVERING

IMPORTANT LONG FINGERS SKIN DEFECTS

F. Katrana, J. Bakhach, E. Demiri, B. Panconi and J.C. GuimberteauInstitut Aquitain de la Main, 56 allee des Tulipes,

Bordeaux-Pessac, France

The digito-metacarpal dorsal flap described by Bakhachin 1999 is a cutaneous flap raised from the dorsal aspectof every inter-metacarpal space of the hand. Itsirrigation is based on a retrograde flow through thedorsal intermetacarpal arteries. These arteries ended ateach web space in terminal branches, which continuewith the dorsolateral digits arterial networks andanastomoses with the first dorsal cutaneous branch ofthe corresponding palmar collateral artery. This con-stant anastomosis is situated at the level of the mid firstphalanx which corresponds to the pivot point of theflap. These particular vascular communications betweenthe dorsal hand network and the digital palmarcollateral arteries offer a wide range of coveringcompetence. With a cutaneous paddle designed on thedorsal aspect of the hand and a pivot point placed at themid length of the first phalanx, the flap can easily reachthe distal end of the long fingers. The operativetechnique of flap harvesting respects the JunctumTendinosum on one side and lets free the MCP jointon the other. These conditions authorise to start an earlydigital physiotherapy. Our clinical experience comprises40 flaps. All of them were carried out for thereconstruction of dorsal or lateral defects of the longfingers situated beyond the middle of the first phalanx.Eighty percent of the cases were a work accident. In87% the patients were male. The distribution of thedigital injuries was: Index finger 30%, third finger37.5%, fourth finger 20% and fifth finger 12.5%. All ourflaps were successful except for two cases where we faced

a partial suffering of the flap extremity, occurring insmoker patients. The treatment consisted of surgicaldebridement and secondary healing without alterationof the final outcome. The donor site was either primarilyclosed with the adding of discharge incisions whenevernecessary, or left to secondary healing when the width ofthe flap exceeded 2.5 cm. We never used skin graft.

10.1016/j.jhse.2007.02.160

A-0313

14.5 GRACILIS FREE MUSCLE FLAP FOR COVER-

AGE OF PALMAR DEFECTS

N. Chahidi, P. Lorea, A. Le Jeune and K. DrossosClinique du Parc Leopold Bruxelles, Belgium

Background: Large and deep soft-tissue defects of thepalm are not very frequent but their reconstruction canbe difficult due to the special anatomy required. Theideal substitute must be durable, relatively immobile,hairless and thin. We are reporting our clinicalexperience using a gracilis free muscle for the recon-struction of the palm of the hand and thenar muscles.Patients and methods: We used the gracilis free muscleflap in five men for covering hand defect in crushinginjuries (n ¼ 2), severe scar contracture (n ¼ 1), gun shotinjury (n ¼ 1) and severe infection (n ¼ 1); the mean agewas 42 years. The gracilis muscle was harvested from theuninjured side and split-thickness skin grafts was used tocover the transplant. In each case, after a radicaldebridement the anastomosis was easily placed outsidethe zone of injury on the ulnar (n ¼ 4) or radial (n ¼ 1)artery. End to side anastomosis was performed for allflaps. The motor branch of the gracilis flap was suturedto the motor branch of median nerve (n ¼ 1). The flapswere examined for appearance, mobility and adherenceto the underlying tissues.Results: The mean follow-up is 12 months (6–36 months).The transplanted muscle provided excellent contour anddurable cover in all five hands. There were no incidencesof partial or complete flap loss. Intact deep pressuresensation was present in all the hand but flaps did notdevelop any sensibility. In three patients the flap wasfirmly adherent with very little mobility. One patient hadslight mobility of his flap but not enough to produce afunctional problem. In two patients the flap was darkerthan the surrounding skin because of the origin of theskin graft. There was no donor-site morbidity.Conclusion: In our experience, the free gracilis muscleflap transplantation provides very satisfactory results inthe treatment of large palmar defects with no donor-sitemorbidity. This same flap can be used for thereconstruction of the thenar muscles and an appropriateopposition function.

10.1016/j.jhse.2007.02.161