Procurement of Extended Vascularized Skin Flaps from The Donor Enables Hand Transplantation in Severe Upper Extremity Burns: An Anatomical Study.

Background: Hand transplantation in patients with severe upper extremity burns can be associated with an increased risk of exposure of vessels, tendons and nerves because of extensive skin and soft tissue deficit. This study evaluated how to reliably transfer additional extended skin flaps with a standard hand allograft. Methods: Twenty-five upper extremities were used. Sixteen were injected with latex to map the perforating branches of the brachial (BA), superior ulnar collateral (SUCA), radial (RA), ulnar (UA) and posterior interosseous (PIA) arteries. Nine hand allografts were procured, injected with blue ink through the BA to assess the perfusion of the skin flaps and then mock transplanted. Results: Sizable perforators from the BA, SUCA, RA, UA and PIA were used to augment the vascularization of the skin flaps. The average stained area of the medial arm flap was between 85.7% and 93.9%. The stained area of the volar forearm flap was the smallest when based on perforators within 6 cm from the wrist crease (51.22%). The dorsal forearm flap showed the least amount of staining (34.7 %- 46.1%). The average time to repair tendons, nerves and vessels was longer when a single volar forearm-arm flap was harvested (171.6 minutes). Harvest of the allograft associated with a distally based forearm flap and islanded arm flap was the fastest (181.6±17.55 minutes). Conclusions: Extended skin flaps, based on perforators of the main axial vessels, can be reliably transplanted with a standard hand allograft based on the brachial or axillary vascular pedicle. Financial Disclosure Statement: The authors have no conflict of interest to disclose. Presented at EURAPS Research Council meeting, 2017 in Pisa, Italy and at Plastic Surgery the Meeting (ASPS), 2017 in Orlando, Florida. Acknowledgment: The authors would like to acknowledge Pierpaolo Marchetti, PhD for the statistical analysis and Ashley Healy for meticulous proofreading and editing the paper. Corresponding Author: Antonio Rampazzo, MD, PhD, Plastic Surgery Department,, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A60-522, Cleveland, OH, USA. E-mail: ©2018American Society of Plastic Surgeons

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