Application of radial-lateral forearm free perforator flap on repairing of soft tissue defects in finger_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Min ¹ , WU Jinying ² , YUAN Zuoxiong ² , TIAN Dehu ³ ,  SHAO Xinzhong ³ , LI Dacun ¹ , LI Jianfeng ¹ , LIU Jingda ¹ , ZHAO Liang ¹ , LI Hailei ¹ , WANG Xiaolei ¹

1. Department of Upper Limb Surgery, Beijing Shunyi Hospital, Beijing, 101300, P.R.China;
2. Department of Anatomy, Capital Medical University Yanjing Medical College, Beijing, 101300, P.R.China;
3. Department of Hand Surgery, the Third Affiliated Hospital of Hebei Medical University, Shijiazhuang Hebei, 050051, P.R.China;

Corresponding author：

SHAO Xinzhong, Email: myhand699@126.com

Keywords：

Perforator flap; skin defect; free grafting; finger; forearm

DOI：

10.7507/1002-1892.201901057

Video：

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Objective To investigate the effectiveness of radial-lateral forearm free perforator flap on repairing of soft tissue defects in the finger.Methods Between January 2017 and May 2018, 26 cases of finger skin defects were treated with radial-lateral forearm free perforator flap based on the radial branch of the posterior interosseus artery. There were 21 males and 5 females, with an average age of 26.6 years (range, 19-56 years). The cause of injury included the cutting injury in 16 cases and crush injury in 10 cases. The interval between injury and admission was 30 minutes to 4 hours (mean, 1.5 hours). The injury located at thumb in 6 cases, index finger in 8 cases, middle finger in 6 cases, ring finger in 3 cases, and little finger in 3 cases; and at the dorsum of finger in 6 cases, the lateral side in 6 cases, and the palm in 14 cases. All wounds were accompanied with the tendon and bone exposures, and phalangeal fractures occurred in 10 cases. The size of the defects ranged from 2.0 cm×1.0 cm to 4.0 cm×2.5 cm. And the size of the flap ranged from 2.5 cm×1.5 cm to 4.5 cm×3.0 cm. All wounds at donor sites were sutured directly.Results All the 26 cases were followed up 4-12 months (mean, 7 months). The 24 flaps survived uneventfully after operation, and the wounds healed by first intention. Partial necrosis occurred at the distal part in 2 flaps, and secondary healing achieved after debridement and dressing. All incisions at donor sites healed by first intention. The appearance and texture of all flaps were satisfactory. The two-point discrimination of the flaps was 5-10 mm (mean, 8 mm) at 4 months after operation. Sensory of the flaps was grade S₃. Only linear scar was noted at the donor site.Conclusion The radial-lateral forearm free perforator flap in repairing of the soft tissues in finger can shorten the disease duration, reduce the damage of the donor site, and improve the patients’ quality of life.

Citation： ZHAO Min, WU Jinying, YUAN Zuoxiong, TIAN Dehu, SHAO Xinzhong, LI Dacun, LI Jianfeng, LIU Jingda, ZHAO Liang, LI Hailei, WANG Xiaolei. Application of radial-lateral forearm free perforator flap on repairing of soft tissue defects in finger. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(5): 586-589. doi: 10.7507/1002-1892.201901057 Copy

1.	Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg, 1987, 40(2): 113-141.
2.	Taylor GI, Corlett RJ, Dhar SC, et al. The anatomical (angiosome) and clinical territories of cutaneous perforating arteries: development of the concept and designing safe flaps. Plast Reconstr Surg, 2011, 127(4): 1447-1459.
3.	Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.
4.	Costa H, Pinto A, Zenha H. The posterior interosseous flap-a prime technique in hand reconstruction. The experience of 100 anatomical dissection and 102 clinical cases. J Plast Reconstr Aesthet Surg, 2007, 60(7): 740-747.
5.	李匡文, 刘俊, 黄新峰, 等. 游离双侧双叶骨间背动脉穿支皮瓣修复四指掌侧皮肤缺损一例. 中国修复重建外科杂志, 2012, 26(12): 1519-1520.
6.	Li KW, Liu J, Liu MJ, et al. Free multilobed posterior interosseous artery perforator flap for multi-finger skin defect reconstruction. J Plast Reconstr Aesthet Surg, 2015, 68(1): 9-16.
7.	黄良库, 许玉本, 李鹏, 等. 游离桡动脉掌浅支皮瓣修复手指软组织缺损. 中国修复重建外科杂志, 2018, 32(7): 955-958.
8.	李木卫, 梁文仙, 罗朝晖, 等. 吻合指背动脉的趾腓背侧动脉皮瓣修复手指背侧皮肤软组织缺损. 中国修复重建外科杂志, 2016, 30(6): 732-735.
9.	Wang L, Xie QP, Wang HJ. Free first dorsal metatarsal artery perforator flap for multiple finger defects reconstruction: a case report. J Hand Surg (Eur Vol), 2018, 43(6): 666-668.
10.	Song D, Pafitanis G, Yang P, et al. Innervated dorsoradial perforator free flap: A reliable supermicrosurgery fingertip reconstruction technique. J Plast Reconstr Aesthet Surg, 2017, 70(8): 1001-1008.
11.	赵民, 田德虎, 邵新中, 等. 腕部掌侧桡动脉掌浅支横行微型皮瓣游离移植修复手指皮肤缺损. 中国修复重建外科杂志, 2013, 27(12): 1475-1479.
12.	赵民, 吴金英, 袁作雄, 等. 腕部掌侧带血供皮瓣游离移植修复手指皮肤缺损的应用解剖研究. 中国临床解剖学杂志, 2013, 31(5): 514-517.
13.	Bijli AH, Bashir SA, Rasool A, et al. Contralateral lumbo-umbilical flap: A versatile technique for volar finger coverage. Indian J Plast Surg, 2017, 50(2): 201-206.
14.	Liu EW, Huang TC, Cheng HT. Simultaneous reconstruction of the thumb defect and coverage of the failed first dorsal metacarpal artery flap donor site by using the anterolateral thigh flap and its vascular pedicle tissue. Microsurgery, 2018, 38(7): 821-822.
15.	Wei FC, Mardini S. Free-style flaps. Plast Reconstr Surg, 2004, 114(4): 910-916.
16.	高伟阳, 姚岳波, 杨新东. 骨间后动脉桡侧支的显微解剖及其临床意义. 中华手外科杂志, 1998, 14(2): 76-78.
17.	Gao W, Yan H, Li Z, et al. The free dorsoradial forearm perforator flap: anatomical study and clinical application in finger reconstruction. Ann Plast Surg, 2011, 66(1): 53-58.
18.	赵民, 吴金英, 袁作雄, 等. 前臂后外侧穿支皮瓣游离移植修复手指皮肤缺损的应用解剖. 中国临床解剖学杂志, 2017, 35(6): 607-609.

1. Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg, 1987, 40(2): 113-141.
2. Taylor GI, Corlett RJ, Dhar SC, et al. The anatomical (angiosome) and clinical territories of cutaneous perforating arteries: development of the concept and designing safe flaps. Plast Reconstr Surg, 2011, 127(4): 1447-1459.
3. Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.
4. Costa H, Pinto A, Zenha H. The posterior interosseous flap-a prime technique in hand reconstruction. The experience of 100 anatomical dissection and 102 clinical cases. J Plast Reconstr Aesthet Surg, 2007, 60(7): 740-747.
5. 李匡文, 刘俊, 黄新峰, 等. 游离双侧双叶骨间背动脉穿支皮瓣修复四指掌侧皮肤缺损一例. 中国修复重建外科杂志, 2012, 26(12): 1519-1520.
6. Li KW, Liu J, Liu MJ, et al. Free multilobed posterior interosseous artery perforator flap for multi-finger skin defect reconstruction. J Plast Reconstr Aesthet Surg, 2015, 68(1): 9-16.
7. 黄良库, 许玉本, 李鹏, 等. 游离桡动脉掌浅支皮瓣修复手指软组织缺损. 中国修复重建外科杂志, 2018, 32(7): 955-958.
8. 李木卫, 梁文仙, 罗朝晖, 等. 吻合指背动脉的趾腓背侧动脉皮瓣修复手指背侧皮肤软组织缺损. 中国修复重建外科杂志, 2016, 30(6): 732-735.
9. Wang L, Xie QP, Wang HJ. Free first dorsal metatarsal artery perforator flap for multiple finger defects reconstruction: a case report. J Hand Surg (Eur Vol), 2018, 43(6): 666-668.
10. Song D, Pafitanis G, Yang P, et al. Innervated dorsoradial perforator free flap: A reliable supermicrosurgery fingertip reconstruction technique. J Plast Reconstr Aesthet Surg, 2017, 70(8): 1001-1008.
11. 赵民, 田德虎, 邵新中, 等. 腕部掌侧桡动脉掌浅支横行微型皮瓣游离移植修复手指皮肤缺损. 中国修复重建外科杂志, 2013, 27(12): 1475-1479.
12. 赵民, 吴金英, 袁作雄, 等. 腕部掌侧带血供皮瓣游离移植修复手指皮肤缺损的应用解剖研究. 中国临床解剖学杂志, 2013, 31(5): 514-517.
13. Bijli AH, Bashir SA, Rasool A, et al. Contralateral lumbo-umbilical flap: A versatile technique for volar finger coverage. Indian J Plast Surg, 2017, 50(2): 201-206.
14. Liu EW, Huang TC, Cheng HT. Simultaneous reconstruction of the thumb defect and coverage of the failed first dorsal metacarpal artery flap donor site by using the anterolateral thigh flap and its vascular pedicle tissue. Microsurgery, 2018, 38(7): 821-822.
15. Wei FC, Mardini S. Free-style flaps. Plast Reconstr Surg, 2004, 114(4): 910-916.
16. 高伟阳, 姚岳波, 杨新东. 骨间后动脉桡侧支的显微解剖及其临床意义. 中华手外科杂志, 1998, 14(2): 76-78.
17. Gao W, Yan H, Li Z, et al. The free dorsoradial forearm perforator flap: anatomical study and clinical application in finger reconstruction. Ann Plast Surg, 2011, 66(1): 53-58.
18. 赵民, 吴金英, 袁作雄, 等. 前臂后外侧穿支皮瓣游离移植修复手指皮肤缺损的应用解剖. 中国临床解剖学杂志, 2017, 35(6): 607-609.

Chinese Journal of Reparative and Reconstructive Surgery

Application of radial-lateral forearm free perforator flap on repairing of soft tissue defects in finger

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