ObjectiveTo explore the effectiveness of the dissociative saphenous arteria flap in repairing upper limbs soft tissue defect. MethodsBetween June 2012 and April 2014, 10 cases of skin and soft tissue defects at the upper limbs were treated, including 6 males and 4 females with an average age of 42 years (range, 23-58 years). The causes of injury was the machine injury in 9 cases, the interval of injury and operation was 2 hours to 32 days (mean, 5.5 days); the locations were the dorsal radial side in 3 cases and the dorsal forearm in 6 cases. Skin defect with tendon exposure was observed in 1 case after contracture of the first web space resection. The defect size varied from 5 cm×3 cm to 16 cm×9 cm. The size of the flaps ranged from 6.0 cm×3.6 cm to 19.2 cm×10.8 cm. In 7 cases, the saphenous nerve was anastomosed with the nerve of the donor (cutaneous nerve, radial nerve, or ulnar nerve); in 5 cases, tendon defect was repaired by sartorius muscle tendon bridge. The donor sites were repaired by free skin graft or suture. ResultsThe other flaps survived and obtained healing by first intention except 1 flap which had partial necrosis with healing by second intention. The skin graft at donor site survived. All patients were followed up 5-17 months (mean, 12 months). The flaps had good color and texture without contracture. At last follow-up, the sensation recovered to S1-S3+; in 7 cases undergoing nerve anastomosis, the sensation reached S3-S3+, and it was better than that not undergoing nerve anastomosis (S1-S2); in 5 cases receiving sartorius muscle tendon bridging, the hand function recovered satisfactorily except 1 case of total active movement (TAM) value >75% of contralateral TAM at last follow-up. According to the Chinese Medical Society of Hand Surgery function evaluation standards, the results were excellent in 8 cases and good in 2 cases. ConclusionThe dissociative saphenous arteria flap is an effective way to repair skin defects of the upper limbs because of reliable blood supply and simple surgical procedure.
ObjectiveTo explore the effectiveness of retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve in the treatment of soft tissue defect of the hand. MethodsBetween October 2011 and December 2013, 17 cases of skin and soft tissue defects of the hands were treated. There were 8 males and 9 females, aged 23-62 years (mean, 44 years). Of them, defect was caused by trauma in 13 cases, by postoperative wound after degloving injury in 2 cases, and by resection of contracture of the first web in 2 cases; 13 cases of traumas had a disease duration of 2-6 hours (mean, 3.5 hours). The defect sites located at the back of the hand in 5 cases, at the radial side of the palm in 4 cases, at the first web in 2 cases, at the palmar side of the thumb in 4 cases, and at the radial dorsal side of the thumb in 2 cases. The bone, tendons, and other deep tissue were exposed in 15 cases. The defect size varied from 3 cm×3 cm to 12 cm×8 cm. The size of the flaps ranged from 3.6 cm×3.6 cm to 13.2 cm×8.8 cm. The lateral cutaneous nerve of the forearm was anastomosed with the cutaneous nerve of the reci pient sites in 9 cases. The donor sites were repaired by free skin graft or were sutured directly. ResultsThe other flaps survived, and obtained healing by first intention except 2 flaps which had partial necrosis with healing by second intention at 1 month after dressing change. The skin graft at donor site survived, and incisions healed by first intention. All patients were followed up 5-30 months (mean, 12 months). The flaps had good color and texture. Flap sensory recovery of S2-S3+ was obtained; in 9 cases undergoing cutaneous nerve flap anastomosis, the sensation of the flaps recovered to S3-S3+ and was better than that of 8 cases that the nerves were disconnected (S2-S3). The patients achieved satisfactory recovery of hand function. Only 2 cases had extended limitation of the proximal interphalangeal joint. At last follow-up, according to the Chinese Medical Society of Hand Surgery function evaluation standards, the results were excellent in 15 cases and good in 2 cases. ConclusionRetrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve is an effective way to repair skin defects of the hand, with the advantages of rel iable blood supply and simple surgical procedure.