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Treatment of unfavourable results of flexor tendon surgery: Skin deficiencies


Elliot, David; Giesen, Thomas (2013). Treatment of unfavourable results of flexor tendon surgery: Skin deficiencies. Indian Journal of Plastic Surgery, 46(2):325-332.

Abstract

We recently reported a small study at the Federation of European Societies for Surgery of the hand, which was entitled 'What is secondary flexor tendon surgery'? This study concluded that 'secondary flexor tendon surgery' was a generic name encompassing a multitude of pathologies. Between 10% and 15% of cases exhibited pathology of the skin and subcutaneous fat and required flap reconstruction of these tissues. Skin replacement may be used prophylactically at primary surgery or become necessary at secondary surgery after release of scar contractures, to achieve cover of vital structures. The long-term problem of skin deficiency relating to flexor tendon function is one of loss of extension from longitudinal scar shortening of the integument, even if the flexor tendons are primarily concerned with bending the digits, not straightening them. This loss of extension can only be tolerated in a hand to a certain degree without significant loss of function. This paper is largely an analysis of the flaps available and suitable for different degrees of skin deficiency and at different places along the course of the flexor system. It attempts to dispel the idea that 'any flap will do' provided the flexors are adequately covered.

We recently reported a small study at the Federation of European Societies for Surgery of the hand, which was entitled 'What is secondary flexor tendon surgery'? This study concluded that 'secondary flexor tendon surgery' was a generic name encompassing a multitude of pathologies. Between 10% and 15% of cases exhibited pathology of the skin and subcutaneous fat and required flap reconstruction of these tissues. Skin replacement may be used prophylactically at primary surgery or become necessary at secondary surgery after release of scar contractures, to achieve cover of vital structures. The long-term problem of skin deficiency relating to flexor tendon function is one of loss of extension from longitudinal scar shortening of the integument, even if the flexor tendons are primarily concerned with bending the digits, not straightening them. This loss of extension can only be tolerated in a hand to a certain degree without significant loss of function. This paper is largely an analysis of the flaps available and suitable for different degrees of skin deficiency and at different places along the course of the flexor system. It attempts to dispel the idea that 'any flap will do' provided the flexors are adequately covered.

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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Reconstructive Surgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:May 2013
Deposited On:04 Mar 2015 16:06
Last Modified:05 Apr 2016 18:54
Publisher:Medknow Publications
ISSN:0970-0358
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.4103/0970-0358.118611
PubMed ID:24501469

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