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Case Reports
. 2022 Aug 9:22:e36.
eCollection 2022.

Pedicled Groin Flap for Reconstruction of Combined First Webspace and Dorsal Hand Contracture

Lauren Jacobson  1 , Rachel Skladman  1 , Charles T Tuggle  2 , Mitchell A Pet  1
Affiliations
Case Reports

Pedicled Groin Flap for Reconstruction of Combined First Webspace and Dorsal Hand Contracture

Lauren Jacobson et al. Eplasty. .

Abstract

Background. The combination of first webspace and dorsal hand contracture is a challenging reconstructive problem. Complete soft tissue release results in a large wraparound defect that spans the radial side of the palm, first webspace, and the transverse dimension of the entire dorsal hand. In these situations local tissue is often compromised, and free flap reconstruction is commonly indicated. However, in cases where patients are unwilling or unable to undergo microsurgical reconstruction, regional tissue transfer provides an alternative reconstructive strategy. This case report describes a series of 3 patients with severe combined contractures of the first webspace and dorsal hand. Each patient was relatively contraindicated for local or free tissue transfer and was treated with 2-stage selective contracture release with progressive dorsal then volar defect creation and coverage using a pedicled groin flap. This operation requires thoughtful planning during soft tissue release to coordinate staged, dorsal then volar, defect creation with the progressive liberation of the groin flap at its distal and then proximal ends.

Keywords: dorsal hand contracture; first webspace contracture; groin flap; regional flap; thumb position.

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Conflict of interest statement

Disclosures: The authors have nothing to disclose, including no conflicts of interest and no source of funding.

Figures

FIGURE 1
FIGURE 1
Case 1: Combined first webspace and dorsal hand contracture.
FIGURE 2
FIGURE 2
Case 1: Surgical markings for contracture release of the dorsal first webspace and dorsal hand, in addition to MCPJ casulotomies. The incision is not carried volarly into the palm at the first operation.
FIGURE 3
FIGURE 3
Case 1: After incision of the dorsal first webspace, the fibrotic and contracted abductor pollicis and first dorsal interosseous muscles are visualized. In this case, complete division was necessary to liberate the thumb.
FIGURE 4
FIGURE 4
Case 1: Contractures affecting the dorsal portion of the first webspace and the dorsal hand have been completely released. MCP joint capsulotomy and pinning has been performed through separate incisions. The thumb has been fixated in a position of radial abduction using 2 intermetacarpal pins.
FIGURE 5
FIGURE 5
Case 1: A right pedicled groin flap is outlined centered along the Dopplered axis of the superficial circumflex iliac artery. The flap is raised from lateral to medial, and the donor defect is closed as much as possible. The flap is tubularized at its base and prepared for inset into the dorsal hand defect.
FIGURE 6
FIGURE 6
Case 1: The pedicled groin flap traverses the partially released first webspace and is inset across the dorsum of the hand.
FIGURE 7
FIGURE 7
Case 1: After 3 weeks, the periphery of the groin flap has healed. This clinical photograph demonstrates occlusion of the base with a Penrose drain prior to division and inset.
FIGURE 8
FIGURE 8
Case 1: After division of the groin flap at its base, several centimeters of excess flap become available. The flap is detubularized and debrided of granulation tissue, and an incision is marked for division of the remaining volar firstst webspace skin contracture.
FIGURE 9
FIGURE 9
Case 1: After incision of the contracted skin of the volar first webspace, the thumb is re-pinned in its final position. The base of the groin flap is used to fill the dead space within the first web space and resurface the volar defect.
FIGURE 10
FIGURE 10
Case 1: On the table result after second-stage operation.
FIGURE 11
FIGURE 11
Case 1: Final postoperative result after secondary first CMC arthrodesis.
FIGURE 12
FIGURE 12
Case 2: Pre- (left and center) and post- (right) operative photographs demonstrating correction of severe dorsal hand and first webspace contracture.
FIGURE 13
FIGURE 13
Case 3: Pre- (left) and post- (right) operative photographs demonstrating correction of severe dorsal hand and first webspace contracture.
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