Dressing of the Axilla Using a Water-Filled Surgical Glove After Axilla Grafting
Usually, after grafting of the axilla, it is difficult to obtain a reliable dressing using traditional materials including tulls and fluffy gauzes. As an alternative to this traditional approach, a sterile surgical glove filled with saline can be used to obtain a bulky dressing.
Optimizing the Correction of Severe Postburn Hand Deformities by Using Aggressive Contracture Releases and Fasciocutaneous Free‐Tissue Transfers
&NA; Severe postburn hand deformities were classified into three major patterns: hyperextension deformity of the metacarpophalangeal joint of the fingers with dorsal contracture of the hand, adduction contracture of the thumb with hyperextension deformity of the interphalangeal joint, and flexion contracture of the palm. Over the past 6 years, 18 cases of severe postburn hand deformities were corrected with extensor tenotomy, joint capsulotomy, and release of volar plate and collateral ligament. The softtissue defects were reconstructed with various fasciocutaneous free flaps, including the arterialized venous flap (n = 4), dorsalis pedis flap (n = 3), posterior interosseous flap (n = 3), first web space free flap (n = 3), and radial forearm flap (n = 1). Early active physical therapy was applied. All flaps survived. Functional return of pinch and grip strength was possible in 16 cases. In 11 cases of reconstruction of the dorsum of the hand, the total active range of motion in all joints of the fingers averaged 140 degrees. The mean grip strength was 16.5 kg and key pinch was 3.5 kg. In palm reconstruction, the wider contact area facilitated the grasping of larger objects. In thumb reconstruction, key‐pinch increased to 5.5 kg and the angle of the first web space increased to 45 degrees. Jebsen's hand function test was not possible before surgery; postoperatively, it showed more functional recovery in gross motion and in the dominant hand. Aggressive contracture release of the bone, joints, tendons, and soft tissue is required for optimal results in the correction of severe postburn hand deformities. Various fasciocutaneous free flaps used to reconstruct the defect provide early motion, appropriate thinness, and excellent cosmesis of the hand. (Plast. Reconstr. Surg. 107: 1, 2001.)
Arterialized Venous Flap for Treating Multiple Skin Defects of the Hand
An arterialized venous flap, with arterial blood flowing only through the vein of the flap, was used in each of five patients to cover multiple digital skin defects caused by trauma or burns. Four flaps survived completely, and one showed 30 percent partial necrosis. Although this procedure will require additional refinement, it permits a certain range of motion of the involved digits prior to flap division and inset.