gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Complications in severe upper limb open injury treated by a Katsaros flap

Meeting Abstract

  • presenting/speaker Luciano Torres - Instituto de Ortopedia e Traumatologia do HCFMUSP, São Paulo, Brazil
  • Rames Mattar Jr - Instituto de Ortopedia e Traumatologia do HCFMUSP, São Paulo, Brazil
  • Guilherme Amariz - Instituto de Ortopedia e Traumatologia do HCFMUSP, São Paulo, Brazil
  • Guilherme Barreiro - Unicamp, Campinas, Brazil
  • Danielle Simao - Instituto de Ortopedia e Traumatologia do HCFMUSP, São Paulo, Brazil
  • Julio Cordoba - Instituto de Ortopedia e Traumatologia do HCFMUSP, São Paulo, Brazil
  • Sergio Okane - Instituto de Ortopedia e Traumatologia do HCFMUSP, São Paulo, Brazil

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1997

doi: 10.3205/19ifssh0981, urn:nbn:de:0183-19ifssh09817

Published: February 6, 2020

© 2020 Torres et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives/Interrogation: Flap described by KATSAROS (1983) combines latissimus dorsi musculocutaneous flap merged with groin flap as a long thoracoabdominus skin island. It allows extensive coverage of upper limb including arm, elbow, forearm, wrist and even hand. There is primary donor site closure; proximal transferred portion is acutely inserted on arm. Distal flap portion works as "jumping flap" and needs revascularization before cutaneous pedicle division.

Flap never reach popularity between reconstructive surgeons. We aim to demonstrate a single case report with post-operative complications in its application, some of them related to flap.

Methods: The subject was a 40 years old male that has sustained an accident with hot plastic industry machine device. Upper limb was tractioned and trapped into 3 cilinders in very high temperature. The mechanics of trauma included crush and burn. On emergency patient developed compartment syndrome and 3rd and 4th (injury deeper than skin) degrees burn. On emergency surgery fasciotomy and desbridement. On second look: distal thumb amputation and desbridement. Transferred to our hospital there was bone and joint exposure at left elbow and left thumb. We made a Katsaros flap and associated an external fixator at iliac crest and forearm as made in some of isolated groin flaps (Figure 1 [Fig. 1]). At 2nd postoperative we noticed a Schantz pin loosed and compressed distal pedicle of flap. It caused vascular suffering on limitrophe area of flap intersection.

At infirmary, after nine days of surgery, brachial artery sustained suddenly rupture. Patient was emergently taken to the theatre and stumps were ligated keep hand perfused (hemoglobin reached 4). Post operative was uneventfull, part of groin flap was reconnected to thumb and hand dorsum. Sucessive partial sking graft in staged surgeries until discharge.

Results and Conclusions: Despite vascular ligation, patient keep a functional upper limb. Our sugestion is avoid external fixation in Katsaros flap. Always be carefull with burns on antecubital fossa and late brachial artery injury. The authors believe it is an underrated big flap for upper limb.