title: Soft-tissue coverage of complex dorsal hand and finger defects using the turnover adipofascial flap.
abstract: Complex hand wounds with exposed tendon or bone often require free tissue transfer. We report results in 13 patients with complex dorsal hand or digital wounds who underwent soft-tissue reconstruction using a turnover adipofascial flap and skin grafting over a 35-month period. The mean patient age was 44 years. Mechanism of injury included the following: three gunshot, four degloving, one table saw, three chain saw, one thumb avulsion, and one crush. Flap sizes varied from 2 × 4 to 10 × 18 cm, involving the dorsum of the hand in four patients, thumb in two patients, index finger in one patient, long finger in three patients, long and ring fingers in one patient, and web space in two patients. Skin graft survival was 100% in 12 patients. One patient died of sepsis from unrelated medical conditions. All fractures were healed at follow-up, and there were no donor site complications. The adipofascial flap is a good alternative to free tissue transfer for the coverage of complex dorsal hand and finger soft-tissue defects and is associated with technical ease, good cosmetic results, and minimal donor site morbidity.
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
authors.forename: D Nicole
authors.initials: DN
authors.lastname: Deal
authors.forename: Jonathan
authors.initials: J
authors.lastname: Barnwell
authors.forename: Zhongyu
authors.initials: Z
authors.lastname: Li
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation; D000328:Adult; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005383:Finger Injuries / Q000175:diagnosis / Q000601:surgery; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006230:Hand Injuries / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D017078:Laser-Doppler Flowmetry; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000601:surgery; D013524:Surgical Flaps / Q000009:adverse effects / Q000098:blood supply*; D013997:Time Factors; D014945:Wound Healing / Q000502:physiology