ABSTRACT
Objective:To summarise the effect of free perforator flap of radial collateral artery on reconstruction of first web contracture after hand injury.Methods:Retrospective analysis was conducted based on the clinical data of patients with first web contracture after hand injury in the Department of Hand and Foot Surgery and Rehabilitation, Guangdong Work Injury Rehabilitation Hospital from November 2019 to June 2022. Ten patients, 8 males and 2 females aged between 27 and 51 years old with an average of 40.5 years old were included. There were 6 left hands and 4 right hands. Width and the included angle of first web were measured before surgery. Four hands were classified as severe first web contracture, and the rest of 6 hands had moderate first web contracture. After release scars of the first web, the areas of wound were 5.5 cm × 2.0 cm - 10.5 cm × 3.0 cm. The flaps sized were 6.0 cm×2.5 cm - 11.0 cm × 3.5 cm. All of flaps carried the posterior cutaneous nerve of forearm. Donor sites were closed directly. All patients were included in postoperative follow-up regularly through outpatient clinic or via WeChat reviews. The colour, texture, process in change of the transferred flaps, donor and recipient sites healing and complications were observed.Results:All 10 flaps survived and the wound healed by first intention. The patients received 7 to 15 months (10.5 months in average) of postoperative follow-up. The flaps were not bulky, texture and colour were satisfactory and without pigmentation. Protective sensations restored in 6 patients. At the last follow-up, average included angle of the first webs was 47.14°±1.68°, in comparison with 35.43°±3.60° before surgery. The average width of first webs was 5.34 cm±0.52 cm, in comparison with 3.17 cm±0.75 cm before surgery, the differences were statistically significant ( P<0.01). Eight hands were rated excellent, and 2 were good. There were only linear scars left at the donor sites, without sign of radial nerve injury. Conclusion:The free perforator flap of radial collateral artery is a safe and effective method for repair of first web contracture after hand injury.
ABSTRACT
Objective To evaluate the method and clinical efficacy of utilizing ilioinguinal chimeric perforator bone flap to repair bone and soft tissue defects of limb.Methods From May,2004 to February,2018,there were 11 patients who were diagnosed as bone and soft tissue defect in the upper or lower extremities,7 of which were repaired by chimeric perforator bone flap with the superficial circumflex iliac artery and 4 of which were repaired by chimeric perforator bone flap with the deep circumflex iliac artery.The size of bone flap ranged from 2.5 cm×2.0 cm× 2.0 cm to 6.0 cm×3.0 cm×2.0 cm,and the flap sizes ranged from 5.0 cm×3.0 cm to 17.0 cm×13.0 cm.The donor sites of the flap were directly sutured.Nine patients were implemented by postoperative followed-up visit in hospital.And the appearance,texture,color,shallow sensation of flaps,fracture healing,limb's function and donor site were observed.Results Postoperative followed-up ranged from 3 to 18 months.All flaps survived.The flaps had satisfactory appearance,texture and color.Osseous tissue of defects healed.The function of injury limb was restored well,which metacarpo-phalangeal joint and carpometacarpal joint's movement with metacarpal defect recovered,and gait were normal without pain.As for the donor sites,1 case had hyperplastic scar while the other only had linear scars.Abdominal hernia and numbness with lower extremities were disappeared.Conclusion Ilioinguinal chimeric perforator bone flap can be designed with different pedicles based iliac bone flap according to the size of bone defects.The donor site is concealed with less trauma and less healing time.The operation position is easy to operate,and clinic efficacy is satisfactory.