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RECONSTRUCTION OF TENDON EXPOSE LEFT WRIST JOINT REGION POST ORIF (OPEN REDUCTION AND INTERNAL FIXATION) USING REVERSE RADIAL FOREARM FLAP
by dr Zico Paradigma - Wednesday, 11 September 2019, 12:06 PM
 
ABSTRACT
Introduction: Exposed tendon is the most common complication, with a prevalence between 6% and 53%, 7.8 and up to 30% of patients have a greater problem after surgery, the defect can be reconstruction with a radial forearm flap and combine with STSG. Surgery could replace to achieve better outcome in this case.
Case: Male patient, 42 years old, Three months before admission when the patient was repairing the roof of the house, the patient fell down from a height of 5 meters, the patient fell to the position of his left hand holding his weight, after the incident the patient complained of pain in the left hand and wrist. After the incident, the patient was taken to the Asifa Gemolong hospital for Surgery. One month before admission the patient was taken to the hospital's Sambi Boyolali for physiotherapy. Because of the limited facilities the patient was referred to Moewardi Hospital
Discussion: The radial forearm flap is a very versatile flap and is at its best as a cutaneous flap. It is ideally suited where complex patterns and designs are required and it is a relatively easy flap to manipulate in a variety of different dimensions. The rich vascular network lends itself to prefabrication either using the local tissue or incorporating distant tissues such as mucosa as grafts. Combining with STSG (Split Thickness Skin Graft) to recover defect may improve of cosmetic about wound healing. Reconstruction with skin graft and restore estetic and function of rom of motion of Wrist Join Region.

Conclusion: There have been reported cases of post ORIF (Open Reduction Internal Fixation) with tendon expose defect. Examination revealed that the exposed tendon in the Wrist Joint (S) area with a size of 3 x 1 cm with the base of the tendon, the defect was closed with a radial forearm flap, leaving an open area with a size of 10 x 8 cm to be covered with STSG (Split Thickness Skin Graft). Defect can be closed with good and STSG take 90%. Further physiotherapy is needed to find out whether there are aesthetic and functional problems in both the sensory and motor functions of the left hand joint space.
Keyword: Tendon expose, reverse radial forearm flap, skin graft




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