Page 19 - Read Online

Page 6 of 10 Ciclamini et al. Plast Aesthet Res 2023;10:62 https://dx.doi.org/10.20517/2347-9264.2022.132

Figure 4. Degloving hand trauma

Figure 5. Thin ALT free flap at 1 year postoperative.

Figure 6. Degloved III-IV fingers (A). Coverage with dermal substitute and FTSK (B). Result after 6 months (C)

after flap harvesting can be an option, even though a wide pyramid area sometimes remains around the
perforator piercing the fascia. The sandwich fascial ALT (SALT) free flap, raised harvesting between the
Scarpa's fascia and the crural fascia, described by Cherubino et al. , could offer a valuable option when
[18]
choosing this reconstructive option. When harvested over the Scarpa's fascia, the DIEP flap provides a large
tissue size and respects thinness and extensibility principles, especially in thin patients. Pure fascial flaps
(like free temporal, serratus, or radial fascial flaps) are helpful, even though their use seems to become less
frequent. Muscle flaps with STSG are always too bulky, and retraction over time represents a disadvantage
in this scenario.

FLAP THINNING
Unlike other regions of the body, which have a large skin surface, and subcutaneous and muscular tissue,
allowing easy primary or secondary skin closure, the hand has nerves and tendons just beneath the skin