ABSTRACT FOR PAPER PRESENTATION
TITLE: Hand injury –soft tissue defect closure methods
Authors: Dr Abilasha Carolina Abraham1, Dr Erel A I Diaz 2
1. Post graduate, Department of General Surgery,
2. Professor, Department of General Surgery
Father Muller Medical College Hospital, Mangalore
BACKGROUND:
Hand is an intricate part of the body that not only covers the underlying
structures but also has specialized functional and sensory components. Soft-
tissue defects of the hand following trauma or tumor resection are frequently
encountered in hand surgery and may result in a temporary or permanent
disability if not managed appropriately. There are wide range of options for hand
injury repair which in a reconstructive ladder ranges from primary wounds
closure, skin grafts, local flaps, distant flaps, and micro-vascular free tissue
transfer.However, selecting the most suitable type of soft tissue cover for a
particular defect can be a challenging process .
REVIEW OF LITERATURE
The hand is an intricate part of the body that plays an essential role in social
functioning, expression, productivity, and interactions with our
environment.1 Skin/soft-tissue envelope of the hand is a complex structure that
not only covers the underlying structures but also has specialized functional and
sensory components. The thick glabrous skin of the palm withstands shearing
forces encountered during daily activities and provides discriminatory sensory
function that transfers touch, pain and temperature, whereas the dorsal skin is
pliable and mobile that permits a wide range of motion of the hand such as
fingers pinch and grip.1-2 Soft-tissue defects of the hand following trauma or
tumor resection are frequently encountered in hand surgery and may result in a
temporary or permanent disability if not managed appropriately.
Over the past decades, several reconstructive procedures and their modifications
have evolved to provide the ideal soft tissue coverage of the
hand.3 Conventionally, these included a range of options of primary wounds
closure, skin grafts, local flaps, distant flaps, and micro-vascular free tissue
transfer.3-6 However, selecting the most suitable type of soft tissue cover for a
particular defect can be a challenging process. Furthermore, the abundance of
currently available reconstructive techniques makes this task rather difficult,
especially for the in experienced surgeon. When choosing one reconstructive
method over the other, it is prudent that the surgeon have a sound knowledge of
all available options, their limitations, complications and expected outcomes.
Reconstruction algorithms such as the reconstructive ladder, reconstructive
elevator and reconstructive matrix have been devised to assist surgeons in
determining the most appropriate type of soft-tissue reconstruction.7-8 Although
sometimes useful, there is no simple schema for reconstruction as every injury is
different and every patient has a unique set of medical conditions. This practical
guide offers an overview of several types of local hand flaps. With these flaps the
majority of small-to-medium sized defects of the fingers, thumb and dorsum of
the hand can be reconstructed with minimal donor site morbidity and excellent
functional and aesthetic results because a tissue defect is replaced with similar
tissue type from the immediate anatomic vicinity of the defect.
OBJECTIVES OF THE STUDY:
1)Here in this case series we will see some of the treatment options for soft tissue
defects of the hand and its associated advantages and shortcomings.
MATERIALS AND METHODS:
Study Population
Our cohort consisted of patients diagnosed with soft tissue defects secondary to
injuries and who required soft tissue defect closure .
Source of data : patients admitted in surgical unit of father muller medical college
.
Study type: retrospective descriptive study
Inclusion criteria :
Patients above the age of 20 years diagnosed to have hand injury who required
soft tissue defect closure
Exclusion criteria:
We excluded patients who were either younger than age 18 years or older than
84 years at the time of diagnosis.
ASSESSMENT TOOL
Computerized Data entry form
Sample size: 10
STATISCAL ANALYSIS
The data collected will be analysed and will be entered into Microsoft excel and
converted into statistical software package for social sciences and to obtain
descriptive statistics.
References
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of the hand. Clinics in plastic surgery. 2011 Oct 1;38(4):591-606.
2. Upton J, Havlik RJ, Khouri RK. Refinements in hand coverage with microvascular
free flaps. Clinics in plastic surgery. 1992 Oct;19(4):841-57.
3. McGregor IA. Flap reconstruction in hand surgery: the evolution of presently
used methods. The Journal of hand surgery. 1979 Jan 1;4(1):1-0.
4.Rockwell WB, Lister GD. Soft tissue reconstruction. Coverage of hand injuries.
The Orthopedic clinics of North America. 1993 Jul;24(3):411-24.
5. Giessler GA, Erdmann D, Germann G. Soft tissue coverage in devastating hand
injuries. Hand clinics. 2003 Feb 1;19(1):63-71.
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coverage of the hand. Plastic and reconstructive surgery. 2015 Feb;135(2):413e.
7.Gottlieb LJ, Krieger LM. From the reconstructive ladder to the reconstructive
elevator.
8. Maciel-Miranda A, Morris SF, Hallock GG. Local flaps, including pedicled
perforator flaps: anatomy, technique, and applications. Plastic and reconstructive
surgery. 2013 Jun 1;131(6):896e-911e.
9.Yannascoli SM, Thibaudeau S, Levin LS. Management of soft tissue defects of
the hand. The Journal of hand surgery. 2015 Jun 1;40(6):1237-44.
10.Jokuszies A, Niederbichler AD, Hirsch N, Kahlmann D, Herold C, Vogt PM. The
pedicled groin flap for defect closure of the hand. Operative Orthopadie und
Traumatologie. 2010 Oct;22(4):440-51.
11.Biswas D, Wysocki RW, Fernandez JJ, Cohen MS. Local and regional flaps for
hand coverage. The Journal of hand surgery. 2014 May 1;39(5):992-1004.
1. Lai CS, Yang CC, Chou CK. The adipofascial turn-over flap for complicated dorsal
skin defects of the hand and finger. British journal of plastic surgery. 1991 Jan
1;44(3):165-9
APPLICATION FORM FOR REQUESTING WAIVER OF CONSENT
Name of Principal Investigator : Dr. Abilash Carolina Abraham
Department : General Surgery
Title of the project : Hand injury –soft tissue defect closure methods
Hand injury –soft tissue defect closure methods.
Please Tick the Reasons for Requesting Waiver of Consent :
Research involves ‘not more than minimal risk’ :
There is no direct contact between the researcher and participant :
Emergency situations as described in ICMR Guidelines :
Any other (please specify)
Statement assuring that the rights of the participants are not violated :
No patient information will be disclosed
State the measures described in the Protocol for protecting confidentiality of data
and privacy of research participant :
No personal indentification will be disclosed
Principal Investigator’s signature with date:
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