Objective To investigate the clinical application of micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist to repair skin defect of finger. Methods Twenty-six cases (26 fingers) with skin defect of finger were repaired with micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist between December 2011 and February 2013. There were 20 males and 6 females with the average age of 31.5 years (range, 20-56 years). The causes of injury included cutting injury in 20 cases and crushing injury in 6 cases. The time from injury to admission was 1-5 hours with an average of 2 hours. Injured fingers included thumb in 6 cases, index finger in 6 cases, middle finger in 6 cases, ring finger in 4 cases, and little finger in 4 cases; the locations were the dorsal side of the finger in 6 cases, lateral side in 6 cases, and the volar of the finger tip in 14 cases; there were 4 cases on the proximal phalangeal skin, 8 cases on the middle phalangeal skin, and 14 cases on the distal phalangeal skin. The defect area ranged from 2.0 cm × 1.5 cm to 4.0 cm × 2.0 cm, and the flap area ranged from 2.5 cm × 2.0 cm to 4.5 cm × 2.5 cm. All the donor sites were directly sutured. Results The flaps of 25 cases survived well after operation, and wound healed by first intention； 1 case had partial necrosis and the wound had a scar healing by changing dressing. All cases were followed up 6-12 months (mean, 10 months). The color and appearance of the flaps were satisfactory with tender texture. The two-point discrimination of the flap was 5-8 mm (mean, 6.8 mm). The donor sites healed primarily without scar contracture and limitation of wrist flexion or extension. Conclusion The micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist is a good option to repair skin defect of finger. It has the advantages of hidden donor site, the same operative field, great comparability of flap and finger skin, and it can be used as a vascularized tendon or nerve graft.
ObjectiveTo investigate the effectiveness of free transverse gracilis myocutaneous flap for soft tissue defects of foot and ankle. Methods Between January 2017 and December 2020, 16 cases (17 feet) of soft tissue defects of foot and ankle were repaired with free transverse gracilis myocutaneous flaps. There were 10 males and 6 females, with an average age of 38 years (range, 23-60 years). There were 9 cases of left foot, 6 cases of right foot, and 1 case of bilateral feet. The causes of soft tissue defect were traffic accident injury in 3 cases, heavy object smash injury in 4 cases, machine injury in 3 cases, infection in 4 cases, electrical burn in 1 case, and synovial sarcoma after operation in 1 case. The wounds located at the distal plantar in 2 cases (2 feet), the heel and ankle in 6 cases (6 feet), the dorsum of the foot in 7 cases (8 feet), and the first metatarsophalangeal joint to the medial malleolus in 1 case (1 foot). The size of wounds ranged from 6 cm×5 cm to 18 cm×7 cm. The size of flap ranged from 11 cm×6 cm to 21 cm×9 cm. The donor site was sutured directly. Results After operation, 1 case (1 foot) of flap vascular crisis, 1 case (1 foot) of partial necrosis of the flap, and 1 case of partial dehiscence of the incision at donor site occurred, all of which healed after symptomatic treatment. The other flaps survived, and the incisions at donor and recipient sites healed by first intention. All patients were followed up 12-36 months (mean, 24 months). Except for 1 case (1 foot) of swollen flap, which underwent two-stage trimming, the other flaps had good shape and texture. All the flaps had a protective feeling. At last follow-up, Kofoed scores of foot and ankle function ranged from 73 to 98 (mean, 89.7); 13 cases were excellent, 2 cases were good, and 1 case was poor, with an excellent and good rate of 93.8%. Linear scar was formed at the donor site without adverse effect on lower limb function. ConclusionThe free transverse gracilis myocutaneous flap is an effective flap for repairing large soft tissue defects of foot and ankle due to its advantages of large excisable area, less variation of vascular anatomy, and concealment of donor site.