[Flap plasty in advanced XXXX ].

@entity1 @entity3145 @entity2074 @entity1159 @entity272
OBJECTIVE: Tension-free skin closure after partial aponeurectomy of fingers in @entity2074 with @entity1159 . INDICATIONS: Contractures of the proximal interphalangeal (PIP) joint >30   in @entity2074 cannot sufficiently treated by Z-plasty due to the contracted @entity272 . CONTRAINDICATIONS: @entity3145 or impaired circulation in the operation region and infections. SURGICAL TECHNIQUE: The primary plan is to place a sliding flap into the incision line with the PIP joint in a flexed position, under regional anesthesia and temporary arrest of the blood supply of the upper arm by cuffing. Definitive incising round the sliding flap after achieving a PIP extension position and covering of the sliding flap either by another dorsal side flap or by full thickness skin graft. POSTOPERATIVE MANAGEMENT: Immobilization in a palmar splint, hand physiotherapy and massaging of the scar. RESULTS: In the time period June 2008 to December 2010 a total of 40 @entity1 were surgically treated. The preoperative angle of contracture in the PIP joint was 30-60   in 25 @entity1 (group 1), 60-90   in 10 @entity1 (group 2) and >  90   in 5 @entity1 (group 3). The angle of contracture 12 months postoperatively was 10-15   in group 1, 20-30   in group 2 and 30-40   in group 3 and after 24 months 15-20   in group 1, 30-45   in group 2 and 40-60   in group 3 . The angle of contracture of the PIP joint was greatest for digit 5. Revision surgery resulted in a poorer outcome. Recovery of sensation lasted up to 2 years after surgery. Complications which occurred were problems in wound healing (4), loss of a flap (1), partial loss of the skin transplant without revision (3), arthrodesis (1) and amputation of digit  5 (1).
