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Case Reports
. 2024 Dec 31;37(4):323-329.
eCollection 2024 Dec.

The clinical application of adipofascial turnover flaps for coverage of severe burn wounds on the digits

N D T Linh  1 , T V Anh  1 , H T Tuan  1 , V Q Vinh  1
Affiliations
Case Reports

The clinical application of adipofascial turnover flaps for coverage of severe burn wounds on the digits

N D T Linh et al. Ann Burns Fire Disasters. .

Abstract
in English, French

This article presents particular occupational burn injuries resulting in a complex defect of the digits. Nine patients with exposed bone or tendon wounds on the digits were successfully treated using the pedicle adipofascial turnover flap overlaid with skin grafts. Electrical and high-temperature contact burns resulted in five and four severe cases, respectively. Flaps were harvested from the adjacent dorsal area of the injured digit and the dimension was 2 to 4 mm wider than the defect base on their reliable blood supply. It was suggested that the advantages of adipofascial turnover flaps include a simple, one-stage procedure and minimal donor site deformity.

Cette article se penche sur des accidents de travail responsables de pertes de substance digitales complexes. Neuf patients avec des expositions osseuses ou des lésions tendineuses digitales ont été traités avec succès par des lambeaux adipo- fasciaux de rotation recouverts d’une greffe de peau. Cinq d’entre eux avaient subi une électrisation et quatre une brûlure par contact. Les lambeaux étaient pris sur la face dorsale adjacente, choisis sur la qualité de leur vascularisation, et mesuraient 2 à 4 mm de plus que la surface à couvrir. Cette technique a pour avantages une reconstruction en 1 temps et une conséquence minime pour le site donneur.

Keywords: adipofascial turnover flap; digits; electrical injury; thermal burns.

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Figures

Fig. 1
Fig. 1
Descriptive illustration of designing a dorsal metacarpal artery perforator (DMAP) adipofascial flap.
Fig. 2
Fig. 2
Case number 1: (A) The defect on dorsum of the middle finger with an exposed tendon; (B) The flap is raised from the dorsal of the proximal phalanx; (C) The dorsal branches of the proper digital artery is detected by the Doppler 8Mhz; (D) The flap is turned over and sutured to the defect. The donor site was closed primary; (E) Immediate post-operation result.
Fig. 3
Fig. 3
Case number 7: (A) The defect on dorsal radial over the dorsum of the ring finger and adjacent third web space with an exposed bone; (B) Flap dissection from the proximal of the second metacarpal bone; (C) The flap was completely elevated; (D) The flap turned over and sutured to the defect. The donor site was closed primary; (E) Appearance 3 months later.
Fig. 4
Fig. 4
Case number 8: (A) The defect in the proximal phalanx exposing bone without periosteum after debridement and the flap is designed with the first and second DMAP (black arrow) in its pedicle; (B) Flap dissection from proximal of the second and third metacarpal bones; (C) The flap is turned over at the level of the neck of the metacarpal bones as a pivot point; (D) The flap is sutured to the defect, then skin grafted and the donor skin is closed primary; (E) The result at 4-month-follow up.
Fig. 5
Fig. 5
(A & B) Flap dissection from the proximal phalanx including the dorsal branches from the proper digital artery in its pedicle. The flap is then elevated and turned over to the distal phalanx. Note the intact paratenon above the flexor extension of the proximal phalanx, which preserves postoperative tendon gliding; (C) Flap healed uneventfully, small linear scar was observed on the donor site.
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References

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