Abstract | BACKGROUND: As we enter an age with new approaches to tissue reconstruction, the emphasis on the adage "like for like" has become even more relevant. This study illustrates the potential for several tailored vascularized composite allotransplantation reconstructive techniques and, in particular, for the management of Volkmann contracture. METHODS: Twenty fresh cadaver dissections and 30 archival lead oxide radiographic studies were examined to (1) identify potential upper limb vascularized composite allotransplantation donor sites (i.e., elbow, forearm, and flexor tendon complex) and (2) demonstrate a "mock transplant" of the vascularized volar forearm allograft for a severe Volkmann ischemia defect. They were designed without skin to reduce antigenicity. RESULTS: The elbow joint was supplied within the brachial angiosome and the flexor tendon complex of the flexor digitorum superficialis and flexor digitorum profundus by the superficial palmar arch of the ulnar angiosome. The forearm allograft of flexor muscles, median, ulnar, and anterior interosseous nerves, when harvested on the brachial vessels, was supplied within the radial, ulnar, and anterior interosseous angiosomes but could be based on the ulnar artery alone because of intramuscular connections with the other territories. A mock transplant was performed with a distal-to-proximal dissection of the allograft, facilitating the best and fastest technique. CONCLUSIONS: CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
|
Authors | G Ian Taylor, David S Sparks, Adam C Gascoigne, Russell J Corlett, Mark W Ashton |
Journal | Plastic and reconstructive surgery
(Plast Reconstr Surg)
Vol. 139
Issue 6
Pg. 1291e-1304e
(Jun 2017)
ISSN: 1529-4242 [Electronic] United States |
PMID | 28538571
(Publication Type: Journal Article)
|
Topics |
- Aged
- Cadaver
- Feasibility Studies
- Female
- Forearm
(blood supply, surgery)
- Humans
- Ischemic Contracture
(surgery)
- Male
- Middle Aged
- Plastic Surgery Procedures
(methods)
- Sensitivity and Specificity
- Vascularized Composite Allotransplantation
(methods)
|