Papers of The 1st Japan Scar Workshop

1. Case Report of Four Patients with Scar Contractures Due to Severe Detrition/Burn in The Hand Who Underwent Reconstructive Surgery with A Free Anterior Lateral Thigh Flap

Kato H, Aoi N, Uchida G, Gonda K, Yoshimura K, Koshima I
Department of Plastic and Reconstructive Surgery, University of Tokyo, Tokyo, Japan

In patients with severe detrition and postburn scar in the hand, simple skin grafting to repair the damage during primary surgery cannot prevent recurrent scar contracture. The functional outcome depends primarily on contracture in the proximal interphalangeal joint and the joint between the thumb and index finger. We propose that reconstructive surgery with a free anterior lateral thigh (ALT) flap results in a good outcome in hand reconstruction. Here we report the procedure and its results in 4 patients (postburn scar: 1, severe detrition: 3). The ALT flap can be planed down, and a relatively large single flap is sufficient to completely cover the palm and dorsum of the hand. The adipose tissue attached to the skin flap aids in movement of the underlying tendon. This reconstruction has additional advantages, including both vascular anastomosis with a flow-through free flap and vascular anastomosis that can achieve blood flow through the free flap using a T-shaped vessel. In conclusion, reconstruction with a free ALT flap is considered useful for the prevention or release of contractures.
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