Adipofascial Turnover Forearm Flap for a Large Defect in Hand after Squamous
Cell Tumor Extirpation. A Case Report
The skin carcinomas are a common cancer in the world; squamous
cell carcinoma is derived from the intermediate layer of the epidermis.
The frequency is 2:1 men and women, which is very rare
before 50-years-old but more frequently around the 70-years-old.
This is an infiltrating tumor which can spread by contiguity,
lymphatic system but in frequent by hematogenous route.
SCC metastases are very rare in the hand, but predominant at the dorsal aspect of it.
For the treatment, various choices are available, depending on the tumor type,
size, location and depth, as well as the age and overall health.
The options include: excisional surgery, Mohs surgery, cryosurgery,
electrosurgery, laser surgery, radiation, photodynamic therapy, topical medications
The significant defect in the dorsal aspect of the hand
is always a challenge for a surgeon, because it is very easy to have
exposure of tendon, muscles, bones and neurovascular structures.
There are several options for soft tissue coverage, some of them
sacrifice a major artery; the most common of these arteries are
based on the radial artery with or without skin.
There are also soft tissue flaps which do not sacrifice major arteries,
among them the posterior interosseous flap, dorsal ulnar flap or
the Adipofascial flap with skin graft.
The last one is based on the vascular anatomy of the upper limb where
there are vascular arches around the joints.
There are perforators arteries which anastomose the posterior and
the anterior interosseous arteries, and also others arteries from the
subcutaneous adipose tissue, which provide blood supply to
the dorsal fascia of the forearm.
Orthop Res Traumatol Open J. 2021; 6(1): 8-11. doi: 10.17140/ORTOJ-6-122