Mid sole free tissue transfer to reconstruct palmar contracture (Case Report)

Mid sole free tissue transfer to reconstruct palmar contracture (A case report) I Nyoman P Riasa, * Sidik Setiamihardja** Sub Department of Plastic & Reconstructive Surgery, School of Medicine, Indonesia University/Cipto Mangunkusumo Hospital; ** Bina Estetika Hospital, Jakarta (Abstract) Reconstruction of palmar flexion contracture is frequently challenging since it requires extensive releases of all structures including soft tissue, bone, tendon, joint and resurfacing of the defect. Exposed bone and tendon may not be appropriate if covered with either split skin graft or full thickness skin graft. The exposed tendon and bone offer less vascular supply for graft survival. Skin graft also will developed secondary contracture during maturation phase. The tendon need some bulk of subcutaneous tissue for smooth gliding. So, flap covering will give superior result. The palm itself has a unique form of skin with thick corneal layer, hairless, lack of sebaceous gland and resembling the plantar skin. Therefore, the plantar is considered to be the most suitable donor site to resurface the palm. This is a report of one case of palmar and digital flexion contracture due to trauma, previously managed by others and resurfaced with split skin graft. Soft tissue release, tendon lengthening and fixation of the phalanx with K wire performed. The palmar defect was resurfaced with mid sole free tissue transfer. This technique provides early motion, wider contact area for grasping, appropriate thinness and excellent cosmesis of the hand. [Indones ] Plast Surg 2002; 1(1):63-7]