Hand Surgery and MicrosurgeryReconstruction of Advanced-Stage Electrical Hand Injury in a One Stage Procedure Using a Prefabricated Medial Lateral Crural Composite FlapJiang, Hao MD, PhD*; Li, Qing Feng MD, PhD*; Gu, Bin MD*; Fu, Kaiding MD†; Zheng, Danning MD*; Liu, Kai MD*; Shen, Guoxiong MD*Author Information From the *Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Second Medical University, Shanghai, People's Republic of China; and †Division of Plastic Surgery, Department of Surgery, Loyola University Medical Center at Chicago, Maywood, IL. Received March 14, 2007 and accepted for publication June 8, 2007. Reprints: Qingfeng Li, MD, PhD, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Second Medical University, 639 Zhizhaoju Road, Shanghai 200011, People's Republic of China. E-mail: [email protected]. Annals of Plastic Surgery: June 2008 - Volume 60 - Issue 6 - p 626-630 doi: 10.1097/SAP.0b013e318137a49e Buy Metrics Abstract To explore the possibility of a one stage restoration of protective sensation and finger flexion after electrical burn of the hand, 5 patients with electrical injuries at the wrist were treated by a new free composite flap, originating from the medial lateral crural skin flap. This flap can repair skin, blood vessels, tendons, and nerves in a one-stage procedure. The harvest of the medial lateral crural flap is described. The posterior tibial vessels provide the arterial supply. The perforators to the flap and the branches to the plantaris tendon and the sural nerve were preserved, and the nerve and tendon were kept within the flap by careful dissection of the crural fascia. At the same time, 3 to 4 tendons of extensor digitorum longus were inserted into the layer between superficial and profoundus crural fascia. Thus, blood vessels, nerves, and tendons were combined into the flap before transplantation. The composite flap was then transplanted into the recipient site of the injured hand to repair the complex defects in a single operation. Flexion and extension function of the fingers was evaluated. Sensory function was tested by the standards recommended by the British Medical Research Council System for evaluating sensibility. Follow-up ranged from 18 to 24 months. Results revealed all flaps survived. The flexion distance from tip to palmar crease and extension distance from tip to horizontal level of 3 patients were 4 to 5 cm and 3 to 4 cm, respectively. At 6 months, 2 patients improved from 6 cm and 5 cm to 4 cm and 4 cm, respectively. The sensation reached to S2 level, and skin temperature rose. The medial lateral crural composite flap is an ideal, one-stage method to restore protective sensation and finger flexion for advanced-stage patients who have suffered severe high voltage electrical injuries in the wrist. © 2008 Lippincott Williams & Wilkins, Inc.