Arch Hand Microsurg.  2021 Mar;26(1):57-62. 10.12790/ahm.20.0072.

Reconstruction of a Mangled Hand with a Thoracodorsal Artery Perforator Free Flap: A Report of Two Cases

• Park HS
• Kim DJ
• Hwang JI

• KMID: 2513207
• DOI: http://doi.org/10.12790/ahm.20.0072

Abstract

Mangled hands are a severely injured condition that is a rare and challenging problem for reconstructive surgeons. Surgical flaps such as anterolateral thigh, radial forearm, or thoracodorsal artery flaps have been used for multiple-digit resurfacing. In this report, we describe two cases of complex defects that included multiple digits in patients who underwent reconstruction with thoracodorsal artery perforator (TDAP) free flaps. All massive soft tissue defects were completely covered with a TDAP free flap. The thinner perforator flap could be harvested, and the patients regained the ability to pinch and grasp. Therefore, the authors present two cases of mangled hands successfully treated with TDAP free flap.

Keyword

Hand injuries; Surgical flaps; Microsurgical free flaps

Figure

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  Fig. 1. The angiogram shows an intact radial artery and its dorsal branch.

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  Fig. 2. (A) The thoracodorsal artery perforator free flap was designed on the basis of the most reliable perforator of the thoracodorsal artery. (B) An 18.0×11.0-cm flap with a 10-cm-long pedicle is shown.

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  Fig. 3. (A) Initial injury status. (B) Emergency postoperative status. (C, D) After thoracodorsal artery perforator free flap coverage. (E) After the division of the thumb and other two fingers. (F) Final debulked status.

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  Fig. 4. (A) The princeps pollicis artery. (B) The princeps pollicis artery runs through the thumb flexor tendon. (C, D) End-to-end anastomosis between the princeps pollicis artery and the second common digital artery.

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  Fig. 5. (A) Initial injury status. (B) Emergency postoperative status. (C) Partial necrosis developed. (D) Identification of the dorsal branch of the radial artery. (E, F) After the thoracodorsal artery perforator free flap coverage. (G, H) Final debulked status.

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  Fig. 6. The princeps pollicis artery directly branches from the dorsal branch of radial artery, then passes through under the flexor tendon.

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