Taçkın ÖZALP, Oğuz ÖZDEMİR, Hüseyin S. YERCAN, Erhan COŞKUNOL, Cengizhan KURT

Ters akımlı dorsal metakarpal flep klinik uygulamaları

Dorsal metakarpal ada flepleri el ve parmak sırtındaki defektlerinin kapatılmasında teknik açıdan zorluk yaratmaması nedeniyle sıklıkla kullanılmaktadır. Bu çalışmada amaç ters akımlı olarak uyguladığımız olguların sonuçlarını ve komplikasyonları değerlendirmek, tekniği gözden geçirmektir. 1995-2002 yılları arasında toplam 34 olguya ters akımlı dorsal metakarpal flep uygulandı. Olguların büyük çoğunluğu dupuytren kontraktürü açılması sonrası gelişen cilt defektleri idi. 2. yada 3. dorsal metakarpal arterler flep için kullanıldı. Hastaların 9'u kadın, 25'i erkek ve ortalama yaşı 44 idi. Operasyon sonrasında hastaları takip süresi ortalama 31 ay oldu. Komplikasyon olarak iki hastada oluşan flep nekrozu debridman ve açık yara tedavisi ile iyileşti. Diabetik bir hastada refleks sempatik distrofi gözlendi, uygun tedavi ile sorun çözüldü. Ters akımlı dorsal metakarpal flep, uygulanması kolay, elin major arteriyel sistemini bozmayan, uygun cilt örtülmesi sağlayan aynı zamanda kemik doku ve sinirin de onarılmasına imkan veren, el dorsali yanında palmar bölgede de kullanabilecek iyi bir flep tekniğidir.

Anahtar Kelimeler:

El, Geriyedönük çalışma, Cerrahi flepler, Ortopedik işlemler, Ameliyat sonrası komplikasyonlar

Clinical applications of the reverse dorsal metacarpal flaps

Dorsal metacarpal island flaps are usually used for hand and finger defects. The aim of this study was reviewing of the operating techniques, the results and the complications of the reversed dorsal metacarpal flap applied cases. Thirty four patients had been operated by using reverse dorsal metacarpal island flap. The majority of cases were the skin defects due to Dupuytren's contracture release. Second or third dorsal metacarpal artery was used for the pedicle of the flaps. There were twenty-five male and nine female in the series and the mean age was 44. The mean follow-up period was 31 months. There were two flap necrosis treated with debridment and open wound treatment. Reflex sympathic distrophy was seen in a diabetic patient and resolved with appropriate treatment.Easy to apply, reverse dorsal metacarpal artery flap is a good technique of coverage on the dorsal and palmar surface of the hand. It protects the major arterial system of the hand and also permit the repair of the bone and nervous tissue.

Keywords:

Hand, Retrospective Studies, Surgical Flaps, Orthopedic Procedures, Postoperative Complications,

PDF

___

1. Foucher G, Braun JB. A new island flaps transfer from the dorsum of the index to the thumb. Plastic and Reconstructive Surg 1979;63:344-3499
2. Early MJ, Milner RH. Dorsal Metacarpal flaps. Br J Plas Surg 1987; 40:333-341.
3. Dautel G, Merle M. Dorsal metacarpal reverse flaps. Anatomical basis and clinical application. J Hand Surg [Br] 1991;16:400-405.
4. Dautel G, Merle M. Direct and reverse dorsal metacarpal flaps. Br.J Plast Surg 1992; 45:125-130.
5. Maruyama Y. The reverse dorsal metacarpal flap. Br J Plas Surg 1990; 43:24-27.
6. Quaba AA, Davison PM. The distally-based dorsal hand flap. Br J Plas Surg 1990; 43:28-39.
7. Santa-Comba A, Amarante J, Silva A, Rodrigues J. Reverse dorsal metacarpal osteocutaneous flap. Br J Plast Surg1997;50:555-558
8. Ekerot L. The distally-based dorsal hand flap for resurfacing skin defects in Dupuytren's contracture. J Hand Surg [Br]. 1995;20:111-114.
9. Pelissier P, Casoli V, Bakhach J, Martin D, Baudet J. Reverse dorsal digital and metacarpal flaps: A review of 27 cases.Plast Reconstr Surg 1999,103:159-165
10. Me Grouther DA. Dupuytren's contracture. In: Green DP, Hotchkiss RN, Pederson WC, editors. Green's operative hand surgery, Vol 1. 4th ed. New York, Churchill Livingstone Co.; 1999.p.563-591.
11. Yang D, Morris SF. Reversed dorsal digital and metacarpal island flaps supplied by the dorsal cutaneous branches of the palmar digital artery. Ann Plast Surg 2001; 46:444-449
12. Chen SL, Chou TD, Chen SG, Chen TY et al. The boomerang flap in managing injuries of the dorsum of the distal phalanx. Plas Reconstr Surg 2000; 106:834-839
13. Masqulet AC, Gilbert A. İntermetacarpal and dorsocommisural flaps. In: Masqulet AC, Gilbert A. Editors. Flaps in limb reconstruction. 1sted. London, Martin Dunitz; 1995, p:93-94.
14. Benito JR, Ferreres A, Rodriguez-Baeza A, Monner J. Is the reversed fourth dorsal metacarpal flap reliable? J Hand Surg [Br] 2000; 25:135-139