title: [Reconstruction of severe contracture of the first web space and wrist by incorporating pedicled retrograde flap of forearm transplantation].
abstract: OBJECTIVE
  To summarize the therapeutic effectiveness of incorporating pedicled retrograde flap of forearm transplantation for reconstructing severe contracture of the first web space and wrist.
  
  
  METHODS
  Between November 2005 and February 2010, 26 patients with severe contracture of the first web and wrist were treated. There were 18 males and 8 females with an average age of 27 years (range, 12-45 years). The locations were the right sides in 15 cases and the left sides in 11 cases. The injury reason included hot water scald in 7 cases, explosion hurt in 5 cases, traffic accident in 3 cases, hot pressing in 5 cases, and flame burns in 6 cases. The duration of scar contracture ranged from 6 to 26 months with an average of 11 months. According to the evaluation standard by GU Yudong et al., all had severe contracture of the first web space, and concomitant injuries included adduction deformity thumb, limitation of the thumb extension and opposition function, and carpometacarpal flexion joint deformity. After scar contracture was released, the defect size ranged from 5.8 cm x 4.5 cm to 11.3 cm x 7.2 cm, which were repaired by the incorporating pedicled retrograde flap of forearm of 6.5 cm x 5.0 cm to 12.5 cm x 8.0 cm at size. The donor sites were directly sutured or repaired with skin graft.
  
  
  RESULTS
  Blister and partial necrosis occurred at the distal end of the flaps in 2 cases, which were cured after dressing change. The other flaps survived and wounds healed by first intention. Incisions at donor sites healed by first intention. Twenty-six patients were followed up 6 to 24 months (mean, 15 months). The patients had functional recovery in thumb adduction and opposition at different degrees. At 6 months after operation, according to the Swanson et al. AMA system for total thumb activity, the total thumb function was improved significantly, and according to Jensen et al. measurement, the width and angle of the first web space were significantly increased, all showing significant differences (P < 0.05).
  
  
  CONCLUSIONS
  Incorporating pedicled retrograde flap of forearm transplantation for repairing severe contracture of the first web space and wrist could augment the first web space and improve the wrist flexible function.
authors: Department of Burn and Plastic Surgery, First Affiliated Hospital, Fuzhou General Hospital of Nanjing Military Region, Putian Fujian 351100, PR China. cjcong95yy@126.com
authors: Jianchong
authors: J
authors: Chen
authors: Zuhuang
authors: Z
authors: Wu
authors: Jianxian
authors: J
authors: Zhu
authors: Yongxin
authors: Y
authors: Huang
authors: Baogen
authors: B
authors: Xie
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002921:Cicatrix / Q000601:surgery; D003286:Contracture / Q000601:surgery*; D005260:Female; D005542:Forearm / Q000601:surgery; D006230:Hand Injuries / Q000601:surgery; D006801:Humans; D008297:Male; D008663:Metacarpus; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D016038:Skin Transplantation; D013524:Surgical Flaps; D014953:Wrist; D055815:Young Adult