Author/Editor		Janežič, Tomaž; Arnež, Zoran M
Title		Nenavaden zaplet pecljatega zadajšnjega interosalnega fascialnega režnja z distalno bazo
Translated title		Unusual complication of distally based pedicled posterior interosseous fascial flap
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 66, št. Suppl 1
Publication year		1997
Volume		str. I-9-11
Language		slo
Abstract		Background and methods. A case of a thirty two year old patient with a full thickness burn on the dorsum of her hand is presented. After the debridement the extensor of the long finger over the MCP joint was exposed. The defect was covered with a distally based pedicled fascial posterior interosseous flap and a full thickness skin graft. Results. Postoperative course was uneventful. The splint holding the wrist in extension and fingers in physiological position was removed on the eleventh day following surgery. The flexion of the wrist and long finger was then substantially restricted with a bowing of the fascial pedicle under the skin. One month after the primary procedure the partial excision of the pedicle had been performed which did not give a satisfactory result in terms of wrist and finger mobility. During the last surgical procedure a complete excision of the pedicle was performed after which the mobility of the wrist and finger is nearly normal. Conclusions. The authors think that such complication of the posterior interosseous flap has not been yet described in the literature and was due to immobillisation of the hand, relative shortage of the pedicle and scarring after the surgery. The authors suggest that the posterior interosceous flap should only be used for coverage of the defects with such localisation which does not require an immobilisation to bring the defect closer to the pivot point of the flap's pedicle. Furthermore the authors do not recommend the use of this flap in cases where prolonged postoperative immunobilisations is necessary which might cause "pedicle contracture".
Summary		Izhodišča in metode. V članku je prikazan primer 32-letne bolnice z globoko opeklino na hrbtišču desnice. Po odstranitvi opeklinske mrtvine je ostala razgaljena kita iztegovalka sredinca. Za kritje razgaljene kite je bil uporabljen zadajšnji interosalni fascialni pecljati reženj z distalno bazo ter prosti kožni presadek cele debeline kože. Rezultati. Po operaciji je celjenje potekalo brez zapletov. Enajsti dan po operaciji smo odstranili opornico, ki je zagotavljala ekstenzijo zapestja in fiziološki položaj tričlenih prstov. Tedaj smo opazili zaprto krčenje zapestja in sredinca, ob katerm se je pod kožo jasno izbočil fascialni pecelj režnja. En mesec po tej rekonstruktivni operaciji je bilo napravljeno delno izrezanje peclja, ki pa ni omogočilo popolne gibljivosti v zapestju in sredincu. Po popolnem izrezanju peclja se je gibljivost v zapestju in sredincu praktično približala normalni. Zaključki. Po mnenju avtorjev zaplet zadajšnjega interosalnega režnja v literaturi še ni bil opisan. Najverjetneje je bil zaplet posledica imobilizacije okončine, relativno kratkega peclja režnja ter brazgotinjenja po operaciji. Avtorja svetujeta uporabo omenjenega režnja za kritje tkivnih vrzeli tkiva, ki so oddaljene od mesta vrtenja peclja samo toliko, da ni potrebna imobilizacija, ki bi približala vrzel točki vrtenja peclja. Prav tako avtorja odsvetujega uporabo omenjenega režnja pri stanjih, kjer je potrebna dolgotrajna pooperativna imobilizacija, ki bi lahko povzročila "pedikularno kontrakturo".
Descriptors		BURNS HAND SURGICAL FLAPS ADULT WRIST JOINT IMMOBILIZATION