Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Great Toe Pulp Graft for the Reconstruction of the Postburn Flexion Contracture in the Fingers

수지 화상 후 굴곡성 구축 치료 시 족질부 이식

  • Seo, Je Won (Department of Plastic Surgery, The Catholic University of Korea, College of Medicine) ;
  • Kwon, Ho (Department of Plastic Surgery, The Catholic University of Korea, College of Medicine) ;
  • Yim, Young Min (Department of Plastic Surgery, The Catholic University of Korea, College of Medicine) ;
  • Jung, Sung-No (Department of Plastic Surgery, The Catholic University of Korea, College of Medicine)
  • 서제원 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 권호 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 임영민 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 정성노 (가톨릭대학교 의과대학 성형외과학교실)
  • Received : 2007.06.07
  • Published : 2007.09.10
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Abstract

Purpose: In case of postburn flexion contracture of the fingers, skin graft, geometrical relaxation techniques, local flap, and free flap have been used. Among these procedures, full-thickness skin grafts from the inguinal area are widely used to reconstruct a postburn flexion contracture in the fingers. But there are many esthetic and functional problems in this procedure. Especially, hyperpigmentation of the skin-grafted fingers poses a troublesome problem, particularly in the patients who have dark colored skin. To solve the problem, we have used pulp graft which was harvested from the lateral aspect of great toe. In the present study, we report pulp graft, with which we have obtained a good result in the treatment of postburn flexion contracture of the fingers. Methods: Between September of 2004 and August of 2006, great toe pulp graft was performed to 20 sites of 15 patients. After release of the postburn flexion contracture using Z-plasty, the composite tissue (pulp) harvested from the lateral aspect of great toe was grafted on the raw surface. Moisture dressing with ointment and foam dressing material was performed. Stratum corneum of the graft got stripped off in two to four weeks after pulp graft. The color of the pulp graft was slightly reddish, then it became similar to the adjacent tissue. Results: There was complete take in all the patients who were treated with pulp graft. Great toe pulp graft provided similar color and texture to the adjacent skin, high rate of graft take, and left only a minimal scar at donor site. Conclusion: Thick keratin layer and inelastic nature of the pulp make this type of the graft much easier and simpler, and ensure a better take. Pulp graft is useful method for the reconstruction of the postburn flexion contracture in fingers.

Keywords

References

  1. Ulkur E, Uygur F, Karagoz H, Celikoz B: Flap choices to treat complex severe postburn hand contracture. Ann Plast Surg 58: 479, 2007 https://doi.org/10.1097/01.sap.0000244973.72940.e3
  2. Murakami M, Hyakusoku H, Ogawa R: The scar band rotation flap. Burns 31: 220, 2005 https://doi.org/10.1016/j.burns.2004.09.012
  3. Ulkur E, Acikel C, Karagoz H, Celikoz B: Treatment of severely contracted fingers with combined use of cross-finger and side finger transposition flaps. Plast Reconstr Surg 116: 1709, 2005 https://doi.org/10.1097/01.prs.0000185666.62304.19
  4. EI Kollali R, Ghoneim I, Azemi MA: V-N plasty for the release of severe postburn contractures. J Plast Reconstr Aesthetic Surg 59: 1424, 2006 https://doi.org/10.1016/j.bjps.2006.01.043
  5. Park S, Hata Y, Ito O, Tokioka K, Kagawa K: Full-thickness skin graft from the ulnar aspect of the wrist to cover defects on the hand and digits. Ann Plast Surg 42: 129, 1999
  6. Bunyan AR, Mathur BS: Medium thickness plantar skin graft for the management of digital and palmar flexion contractures. Burns 26: 575, 2000 https://doi.org/10.1016/S0305-4179(00)00014-0
  7. Yoo SI, Kim KS, Kim DY, Lee SY, Cho BH, Lee SW: Compatibility of ankle skin as a full thickness donor site for palmar reconstruction. J Korean Soc Plast Reconstr Surg 29: 70, 2002
  8. Klatsky SA, Manson PN: Toe pulp free grafts in nipple reconstruction. Plast Reconstr Surg 68: 245, 1981 https://doi.org/10.1097/00006534-198108000-00026
  9. Hong IP, Lee SJ, Lee HB, Chung YK: Reconstruction of fingertip and stump using a composite graft from the hypothenar region. Ann Plast Surg 51: 57, 2003 https://doi.org/10.1097/01.SAP.0000054340.77574.D8
  10. Bubak PJ, Richey MD, Engrav LH: Hook nail deformity repaired using a composite toe graft. Plast Reconstr Surg 90: 1079, 1992 https://doi.org/10.1097/00006534-199212000-00024
  11. William F Blair, Curtis M Steyers(eds): Techniques in hand surgery. 1st ed, Baltimore, Williams & Wilkins, 1996, P 18
  12. Bae BM, Eo SR, Kim IK, Koh SH, Jones NF: Correction of syndactyly using pentagonal flap with minimal skin graft. J Korean Soc Plast Reconstr Surg 34: 64, 2007