• Archives of Plastic Surgery
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• v.38 no.6
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• pp.829-835
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• 2011

Purpose: The two major concerns in skin grafting are poor color match in the recipient site and the donor site morbidity. And, glabrous skin on the palmar aspect of the hands and plantar aspect of the feet attributes define the skin on the palm and fingers sole as functionally and aesthetically different from skin on other parts of the body. When there is a glabrous skin defect, it should be replaced with similar skin to restore function and aesthetics. The palmar crease areas were used to minimize these problems. The purpose of this study is to present the precise surgical technique of the full thickness skin graft using distal palmar and midpalmar creases for aesthetic better outcome for hand injuries. Methods: From May 2006 to April 2010, 10 patients with 11 defects underwent glabrous full thickness skin grafting of finger defects. Causes included seven machinery injuries, two secondary burn reconstructions, and one knife injury. Donor sites included ten glabrous full thickness skin graft from the distal palmar crease and one from the midpalmar crease. Results: Follow-up ranged from 3 months to 24 months. All glabrous skin grafts demonstrated complete taking the recipient sites and no incidence of the complete or partial loss. The donor site healed without complications, and there were no incidences of significant hypopigmantation, hyperpigmentation, or hypertrophic scarring. Conclusion: The important aspects of this method involve immediate return of glabrous skin to the defect site and restoration of the recipient site's crease by simple primary closure from adjacent skin. The glabrous skin of the palm provides the best tissue match for the reconstruction of the hands, but only a limited amount of tissue is available for this purpose. Full thickness skin grafting using palmar crease of the defects is the ideal way of reconstructing glabrous skin to restore both function and aesthetics and minimize donor site morbidity.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.649-654
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• 2011

Purpose: Split-or full-thickness skin grafts are used to reconstruct palmar skin and soft tissue defects after trauma or to release burn scar contracture on the hand. Glabrous skin defects should be substituted with similar skin to preserve function and aesthetics. The authors report their experiences with a technique that uses a full-thickness graft taken from glabrous skin on the ulnar edge of the palm for the reconstruction of soft tissue defects of the hand. Methods: During a three-year period from 2007 to 2010, 22 patients with burn scar contracture and 12 patients with post-traumatic skin defects on their hands were treated with full-thickness skin graft operations. The palmar skin and soft tissue defects after release of burn scar contracture or debridement of post-traumatic wounds were reconstructed with full-thickness skin grafts harvested from the ulnar border of their palms. All donor-site wounds were primarily closed. Results: The followup periods ranged from 3 to 25 months. Contractures of the hand were corrected without recurrence, and the grafts showed relatively good contour and color match to the adjacent fields. There were no reported complications such as significant color change or hypertrophic scarring. The grafted skin showed an average 5.9 mm static two-point discrimination obtained in fingertip reconstruction cases, indicating satisfactory reinnervation. Conclusion: Glabrous full-thickness grafts harvested from the palmar ulnar border is a very useful way of reconstructing soft tissue defects on hands, including fingertips, for function restoration, favorable aesthetic results, and low donor-site morbidity.

• Archives of Reconstructive Microsurgery
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• v.24 no.2
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• pp.50-55
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• 2015

In the hand, few vessels can be classified as 'perforators'. Even today, the debate continues on whether or not branches of the digital artery should be considered as perforators. However, 'perforator' and 'perforator flaps' have become extremely popular within the microsurgery literature, and as such, the terminology has found widespread adoption across the hand surgery field. The finger is the most important sensory organ for tactile stimulation. The glabrous skin can be distinguished between the fingertip and the proximal tissue, with the fingertip having a higher functional and, therefore, reconstructive priority. Thus, sacrifice of the proximal glabrous skin can be justified in the reconstruction of fingertip defects. In this paper, the author reviews two flaps, 'lateral digital artery perforator flap' and 'volar digital artery perforator flap', both of which uses short branches of the digital artery as a vascular pedicle and are useful in fingertip construction.

• Archives of Plastic Surgery
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• v.47 no.5
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• pp.435-443
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• 2020

Background The innervated radial artery superficial palmar branch (iRASP) flap was designed to provide consistent innervation by the palmar cutaneous branch of the median nerve (PCMN) to a glabrous skin flap. The iRASP flap is used to achieve coverage of diverse volar defects of digits. However, unexpected anatomical variations can affect flap survival and outcomes. Methods Cases in which patients received iRASP flaps since April 1, 2014 were retrospectively investigated by reviewing the operation notes and intraoperative photographs. The injury type, flap dimensions, arterial and neural anatomy, secondary procedures, and complications were evaluated. Results Twenty-eight cases were reviewed, and no flap failures were observed. The observed anatomical variations were the absence of a direct skin perforator, large-diameter radial artery superficial palmar branch (RASP), and the PCMN not being a single branch. Debulking procedures were performed in 16 cases (57.1%) due to flap bulkiness. Conclusions In some cases, an excessively large RASP artery was observed, even when there was no direct skin perforator from the RASP or variation in the PCMN. These findings should facilitate application of the iRASP flap, as well as any surgical procedures that involve potential damage to the PCMN in the inter-thenar crease region. Additional clinical cases will provide further clarification regarding potential anatomical variations.

• Archives of Reconstructive Microsurgery
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• v.11 no.2
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• pp.153-161
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• 2002

Purpose : Plantar surfaces, calcaneal area, and region of Achilles insertion, which are extremely related with weight-bearing area and shoes application, must be reconstructed with glabrous and strong fibrous skin. Numerous methods of reconstructing defects of these regions have been advocated, but the transfer of similar local tissue as a cutaneous flap with preservation of sensory potential would best serve the functional needs of the weight-bearing and non-weight-bearing surfaces of this region. Therefore it is recommended to use the limited skin of medial surface of foot that is similar to plantar region and non-weight-bearing area. In this paper we performed the medial plantar flap transfered as a fasciocutaneous island as one alterative for moderate-sized defects of the plantar forefoot, plantar heel, and area around the ankle in 25 cases and report the result, availability and problem of medial plantar flap. Materials and methods : We performed proximally based medial plantar flap in 22 cases and reverse flow island flap in 3 cases. Average age was $36.5(4{\sim}70)$ years and female was 3 cases. The causes of soft tissue defect were crushing injury on foot 4 cases, small bony exposure at lower leg 1 case, posterior heel defect with exposure of calcaneus 8 cases, severe sore at heel 2 cases, skin necrosis after trauma on posterior foot 4 cases, and defect on insertion area of Achilles tendon 6cases. Average follow up duration was 1.8(7 months-9.5 years) years. Results: Medial plantar flaps was successful in 22 patients. 18 patients preserved cutaneous branches of medial plantar nerve had sensation on transfered flap but diminished sensation or dysesthesia. At the follow up, we found there were no skin ulceration, recurrence of defect or skin breakdown in all 18 patients. But there was one case which occurred skin ulceration postoperatively among another 4 cases not contained medial plantar nerve. At the last follow up, all patients complained diminished sensation and paresthesia at medial plantar area distally to donor site, expecially with 4 patients having severe pain and discomfort during long-time walking. Conclusion : Medial plantar island flap based on medial plantar neurovascualr pedicle have low failure rate with strong fibrous skin and preserve sensibility of flap, so that it is useful method to reconstruct the skin and soft tissue defect of foot. But it should be emphasized that there are some complications such like pain and paresthesia by neuropraxia or injury of medial plantar nerve at more distal area than donor site. We may consider that medial plantar flap have limited flap size and small arc of rotation, and require skin graft closure of the donor defect and must chose this flap deliberately.

• Archives of Plastic Surgery
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• v.51 no.1
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• pp.94-101
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• 2024

Background For the small glabrous skin defect, Thenar and Hypothenar skin are useful donors and they have been used as a free flap. Because of similar skin characteristics, both flaps have same indications. We will conduct comparative study for the donor morbidity of the Free thenar flap and Hypothenar free flap. Methods From January 2011 to December 2021, demographic data, characteristics of each flap, and complications using retrospective chart review were obtained. Donor outcomes of the patient, who had been followed up for more than 6 months, were measured using photographic analysis and physical examination. General pain was assessed by Numeric Rating Scale (NRS) score, neuropathic pain was assessed by Douleur Neuropathique 4 Questions (DN4) score, scar appearance was assessed by modified Vancouver Scar Scale (mVSS), and patient satisfaction was assessed on a 3-point scale. Statistical analysis was performed on the outcomes. Results Out of the 39 survey respondents, 17 patients received Free thenar flaps, and 22 patients received Hypothenar free flaps. Thenar group had higher NRS, DN4, and mVSS (p < 0.05). The average scores for the Thenar and Hypothenar groups were 1.35 and 0.27 for NRS, 2.41 and 0.55 for DN4, and 3.12 and 1.59 for mVSS, respectively. Despite the Hypothenar group showing greater satisfaction on the 3-point scale (1.82) compared with the Thenar group (1.47), the difference was not significant (p = 0.085). Linear regression analysis indicated that flap width did not have a notable impact on the outcome measures, and multiple linear regression analysis revealed no significant interaction between flap width and each of the outcome measures. Conclusion Despite the limited number of participants, higher donor morbidity in general pain, neuropathic pain, and scar formation was noted in the Thenar free flap compared with the Hypothenar free flap. However, no difference in overall patient satisfaction was found between the two groups.

• The Korean Journal of Mycology
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• v.21 no.2
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• pp.133-139
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• 1993

Common dermatophytosis in upper Egypt were studied at three hospitals in Minia city. Tinea corporis (ringworm of glabrous skin) was diagnosed in 127 patients (84 males and 53 females). Trichophyton was the most common genus and was represented by 6 species among which T. violaceum was the commonest fungus. Microsporum was represented by 4 species and M. canis was the prevalent species. Tinea pedis (ringworm of the foot) was noticed in 22 cases (13 males and 9 females) and also Trichophyton and Microsporum were the causal organisms. Three species of Trichophyton namely: T. violaceum, T. kuryngei and Trichophyton sp. were isolated. Tinea cruis (ringworm of the groin) was diagnosed in 21 patients (16 males and 5 females). Epidermophyton floccosum was the most prevalent fungus associated with tinea cruris whereas Trichophyton and Candida were less frequent. Tinea unguium (ringworm of the nail) was diagnosed in 9 patients, 8 were females and one was male and the age incidence ranged between 5 and 55 years. M. canis occurred in 2 cases and T. mentagrophytes in one case. Out of 86 cases of tinea versicolor, 71 were males and 15 were females. Malassezia furfur was the main causal agent. All patients of candidiasis and paronychia were females and Candida was the most prevalent causal agent.

• Archives of Reconstructive Microsurgery
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• v.21 no.1
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• pp.21-26
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• 2012

The radial artery superficial palmar branch free flap is based on the perforators of the superficial palmar branch of the radial artery and its venae comitantes. This flap can be used as a sensible flap including palmar cutaneous branch of the median nerve. Forty radial artery superficial palmar branch free flaps were performed at Centum Institute during October 2010 to December 2011. There were 32 males and 8 females and their mean age were 48 years (range 30 to 66 years). The thumb injured in 13 patients, the index finger in 16 patients, the middle finger in 4 patients, the ring finger in 2 patients, and the little finger in 5 patients. The mean size of the flap was $2.5{\times}3.5$ cm(range $2{\times}2.5$ to $3{\times}7$ cm). The donor site was always closed primarily. The overall survival rate was 90.2 percent. The flaps showed well-padded tissue with glabrous skin. All patients have touch sensation and showed 12 mm two point discrimination in an average(range 8 to 15 mm). Donor site morbidity was conspicuous. One patient showed unsightly scar. Early postoperative range of motion of the affected thumb showed slightly limited radial and palmar abduction. But it improved after postoperative 2 months, and patients did not complaint limitation of motion. In conclusion, the radial artery superficial palmar branch free flap can be used as an option for soft tissue reconstruction of finger defects where local or island flaps are unsuitable.