Outcomes of free adipofascial flaps combined with tenolysis in scarred beds.
OBJECTIVE
To review our outcomes of transferring vascularized free adipofascial flaps used to change the local tissue conditions at the time of tenolysis in adhesion-prone beds.


METHODS
Eleven free adipofascial flaps were transplanted in 10 patients after tenolysis on the forearm (3 cases), the dorsum of the hand (5 cases), or the dorsum of the proximal phalanx (3 cases). All recipient areas had badly scarred beds, 7 of which had previously failed tenolyses. In addition to tenolysis (10) or the insertion of bridging tendon grafts (1), arthrolysis of several involved joints and bone fixation for nonunion (3 cases) were carried out simultaneously. The adipofascial flap was then wrapped around the tendons or interposed between the scarred tissue and the freed tendons. In 8 cases, the flap was the lateral arm adipofascial flap, whereas adipose flaps from the toes were used for the fingers.


RESULTS
All flaps survived without vascular crisis. In all cases, total active motion was similar to the passive motion obtained at surgery. Average Disabilities of the Arm, Shoulder, and Hand score improved from 69 to 10, and average Patient-Rated Wrist Hand Evaluation score improved from 65 to 9. Secondary surgery was needed to reduce the bulk of the flap in 3 patients. One patient required an additional procedure to obtain an optimum result.


CONCLUSIONS
Free adipofascial flaps provided satisfying results in this group of patients. The flaps should be considered when the bed is scarred or after a failed tenolysis.


METHODS
Therapeutic IV.
Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain. Electronic address: drpinal@drpinal.com.
Francisco
F
del Piñal
Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain.
Eduardo
E
Moraleda
Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain.
Guillermo H
GH
de Piero
Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain.
Jaime S
JS
Ruas
D000293:Adolescent; D000328:Adult; D002921:Cicatrix / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005383:Finger Injuries / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D005543:Forearm Injuries / Q000503:physiopathology / Q000601:surgery*; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000601:surgery*; D006230:Hand Injuries / Q000503:physiopathology / Q000601:surgery*; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D012086:Reoperation; D013710:Tendons / Q000503:physiopathology / Q000637:transplantation*; D000267:Tissue Adhesions / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
Microsurgery; crushed hand; frozen hand; tendon surgery; tenolysis