Mateusz Gładysz FESSH prep

FESSH prep Microsurgery Contour change in denervated muscle flaps, risk factors for infection and flap loss in the traumatised upper limb, fascial flaps for the dorsum of the hand, timing of free tissue transfer after trauma, muscle versus fasciocutaneous flaps

Free flaps for hand and forearm cover

Last reviewed v1.0

FESSH-082Microsurgery●●○ intermediate

Regarding free tissue transfer for soft-tissue cover of the hand and forearm:

  1. 1.A denervated free muscle flap can lose volume through muscle atrophy, changing the contour after reconstruction.

  2. 2.In a large series of free flaps to the traumatised upper limb, injuries proximal to the elbow were associated with a higher rate of flap failure.

  3. 3.A free serratus anterior fascial flap covered with a skin graft gives thin cover over the dorsum of the hand that allows the extensor tendons to glide.

  4. 4.In Godina's series of extremity trauma, free flaps transferred within 72 hours of injury had lower flap failure and infection rates than those transferred between 72 hours and 3 months.

  5. 5.Muscle-based free flaps to the upper limb have lower rates of partial flap necrosis than fasciocutaneous flaps.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-082
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. A denervated free muscle flap can lose volume through muscle atrophy, changing the contour after reconstruction.

    True

    The early contour of a transferred muscle flap may change as the muscle atrophies and postoperative oedema resolves. A fascia-only flap contains no muscle belly. This distinction matters when planning thin cover, but does not establish universal aesthetic superiority for either flap type.

    • Fox P, Endress R, Sen S, Chang J. Fascia-only anterolateral thigh flap for extremity reconstruction. Annals of plastic surgery. 2014;72 Suppl 1:S9-13. PMID 24691305
    • Wettstein R, Largo RD, Raffoul W, Schumacher R, Schaefer DJ, Kalbermatten DF. Laser scanning evaluation of atrophy after autologous free muscle transfer. Annals of plastic surgery. 2014;72(6):680-4. PMID 23486115
    • Koban KC, Kuhlmann C, Wachtel N, Hirschmann M, Hellweg M, Karcz KW, et al.. To Shrink or Not to Shrink? An Objective Assessment of Free Gracilis Muscle Volume Change in Lower-Extremity Defect Reconstruction. Journal of clinical medicine. 2024;13(16):4811. PMID 39200956

  2. 2. In a large series of free flaps to the traumatised upper limb, injuries proximal to the elbow were associated with a higher rate of flap failure.

    False

    Gupta and colleagues analysed 282 free tissue transfers to the traumatised upper limb. Injury proximal to the elbow and open fracture were associated with more infection, but injury location did not predict flap failure; Gustilo IIIC fractures and anastomotic revision at the index operation did.

    • Gupta A, Lakhiani C, Lim BH, Aho JM, Goodwin A, Tregaskiss A, et al.. Free tissue transfer to the traumatized upper extremity: Risk factors for postoperative complications in 282 cases. J Plast Reconstr Aesthet Surg. 2015;68(9):1184-90. PMID 26212638

  3. 3. A free serratus anterior fascial flap covered with a skin graft gives thin cover over the dorsum of the hand that allows the extensor tendons to glide.

    True

    Ulrich and colleagues used free serratus fascial flaps with an immediate partial-thickness skin graft in nine patients with palmar, dorsal and finger defects, and all recovered useful hand function without bulk. Tuncer and colleagues reported thin, durable cover that facilitated tendon gliding in 13 distal-limb reconstructions. Both series are small.

    • Ulrich D, Fuchs P, Bozkurt A, Pallua N. Free serratus anterior fascia flap for reconstruction of hand and finger defects. Arch Orthop Trauma Surg. 2010;130(2):217-22. PMID 19271229
    • Tuncer S, Sezgin B, Sencan A, Sari A. Free Serratus Fascia Flap for Reconstruction of Soft Tissue Defects Involving the Distal Upper and Lower Extremity. Ann Plast Surg. 2020;84(6):672-678. PMID 31800562

  4. 4. In Godina's series of extremity trauma, free flaps transferred within 72 hours of injury had lower flap failure and infection rates than those transferred between 72 hours and 3 months.

    True

    Godina reviewed 532 patients after extremity trauma. Flap failure was 0.75% with transfer within 72 hours versus 12% between 72 hours and 3 months, and postoperative infection 1.5% versus 17.5%. The series was not limited to the upper limb.

    • Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg. 1986;78(3):285-92. PMID 3737751

  5. 5. Muscle-based free flaps to the upper limb have lower rates of partial flap necrosis than fasciocutaneous flaps.

    False

    In Koepple and colleagues' review of 164 upper-limb free flaps, partial necrosis was more frequent in muscle-based flaps (22.4% versus 8.6%), although muscle flaps covered larger defects and partial necrosis did not differ significantly in flaps larger than 300 cm². Total flap loss and survival after revision were comparable.

    • Koepple C, Kallenberger AK, Pollmann L, Hundeshagen G, Schmidt VJ, Kneser U, et al.. Comparison of Fasciocutaneous and Muscle-based Free Flaps for Soft Tissue Reconstruction of the Upper Extremity. Plast Reconstr Surg Glob Open. 2019;7(12):e2543. PMID 32537297