title: [Scapular/parascapular double skin-paddle free flap for transfixing blast injuries of the hand. A case report].
abstract: Balistic transfixing hand traumas require a complex reconstruction management. Stabilization and reconstruction of the injuried tissues need a double skin-paddle coverage. We present an original case report of a double skin-paddle scapular/parascapular free flap used to cover a through and through gunshot injury of the right hand. A 14-years-old patient presents a severe and extensive wound with full-thickness palmar and dorsal skin defects, dislocation of the carpal bones, median nerve and flexor tendons losses. Distal vascularization is maintained by the deep palmar arch system supplied by the ulnar artery. The radial artery is severed at the level of the first dorsal interosseous space. The measured defect of the dorsal skin was 12×7cm and the palmar one was 6×3cm. After skeletal stabilization, tendinous and nerve preparation, the hand coverage was performed using a double skin-paddle scapular/parascapular free flap. The vascular anastomoses include an end-to-side arterial suture between the circumflex scapular and the radial arteries, and an end-to-end venous suture between the circumflex scapular and the dorsal radial veins. The scapular/parascapular double skin-paddle free flap is a safe and reliable technique to achieve a dorsal and palmar hand coverage in lack of local flaps alternatives. It can be used as a good option prior to bone graft, tendinous and nervous reconstruction.
authors.affiliation: Service de chirurgie maxillo-faciale et plastique, hôpital central, CHU de Nancy, 22, avenue Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France. Electronic address: thomas.colson@gmail.com.
authors.forename: T
authors.initials: T
authors.lastname: Colson
authors.affiliation: Service de chirurgie orthopédique infantile, plastique reconstructrice de l'appareil locomoteur SOS main, hôpital d'Enfant, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-les-Nancy cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Pozetto
authors.affiliation: Service de chirurgie orthopédique infantile, plastique reconstructrice de l'appareil locomoteur SOS main, hôpital d'Enfant, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-les-Nancy cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Gibert
authors.affiliation: Service de chirurgie orthopédique infantile, plastique reconstructrice de l'appareil locomoteur SOS main, hôpital d'Enfant, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-les-Nancy cedex, France. Electronic address: g.dautel@chu-nancy.fr.
authors.forename: G
authors.initials: G
authors.lastname: Dautel
mesh_terms: D000293:Adolescent; D001753:Blast Injuries / Q000601:surgery*; D058752:Free Tissue Flaps / Q000601:surgery*; D006230:Hand Injuries / Q000601:surgery; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012540:Scapula
keywords: Blast; Blast injuries; Chirurgie reconstructive; Free tissue flaps; Gunshot; Hand injuries; Lambeau libre; MeSH; Reconstructive surgical procedure; Traumatisme balistique; Traumatisme de la main; Wounds