ABSTRACT
Objective: To investigate the feasibility and effectiveness of thoracodorsal artery perforator (TDAP) flap for repairing serious scar contracture of the opisthenar. Methods: Between March 2015 and June 2017, 7 cases of serious scar contracture of opisthenar were repaired with TDAP flaps. There were 5 males and 2 females with an average age of 31 years (range, 11-48 years). The time from injury to operation was 8-67 months, with an average of 42 months. After the relocation of the joint and release of the scar, the size of soft tissue defect ranged from 5 cm×4 cm to 10 cm×8 cm. The size of TDAP flap ranged from 5.5 cm×5.0 cm to 10.5 cm×9.0 cm. Results: All flaps survived completely with primary healing at both donor site and recipient site. The flaps of 3 patients were bulky and underwent second-stage skin flap thinning at 3 months after operation. All 7 patients were followed up 6-32 months, with an average of 15 months. The skin flaps were soft and elastic. According to the upper limb function evaluation system recommended by Chinese Society of Hand Surgery, sensory function was classified as S3+ in 2 cases, S3+ in 1 case, S2+ in 3 cases, and S11+ in 1 case. The hand function was excellent in 2 cases, good in 4 cases, and fair in 1 case. There was no significant effect on shoulder movement. Conclusion: The TDAP flap is an ideal method for serious scar contracture of opisthenar.
ABSTRACT
Objective To explore the surgical technique and clinical effects of free anterolateral thigh flaps with fascia lata for repair of dorsal tendon and soft tissue defect of ophisthenar.Methods From February,2014 to July,2016,dorsal tendon and soft tissue defect of ophisthenar in 13 cases was repaired by free anterolateral thigh flaps with fascia lata.The area of soft tissue defect was 5.0 cm×6.0 cm-9.0 cm×12.0 cm.Extensor tendon defect and bone exposure occurred in all cases.The area of flap was 6.0 cm×7.0 cm-10.0 cm×13.0 cm,while the area of anterolateral thigh flap was 3.0 cm×4.0 cm-6.0 cm×8.0 cm.The regular post-operatively followed-up was performed.Results All flaps survived.The donor sites healed well without skin graft.The followed-up time was 6-36 months with the average of 13 months.The appearance of the flap was good.The color and texture of flaps was similar to the dorsal skin of ophisthenar.Three female patients who were not satisfied with the flap appearance received the revision and the results were satisfactory.The activity of finger flexion and extension was satisfactory.All patients walked well without difficulty.According to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association,the function recovery result was excellent in 8 cases,good in 4 cases,and poor in 1 case.Conclusion It is a good method to use the free anterolateral thigh flaps with fascia lata to repair of dorsal tendon and soft tissue defect of ophisthenar.
ABSTRACT
Objective To explore clinic effect and advantages of the free arm lateral neurocutaneous flap in repairing cutaneous defects of opisthenar.Methods Between July,2012 and December,2013,12 patients with skin and soft tissue defects in opisthenar caused by trauma factor,accident,machine injury,hot crush injury etc were treated with free arm lateral neurocutaneous flap at our institution.Vessels both in recipient and donor site were detect-ed by color Doppler ultrasound preoperatively.Relative cutaneous nervers were reserved in the flap during selective operation.The flap size resected range from 6 cm × 4 cm to 10 cm × 6 cm.The posterior cutaneous nerve of the forearm were included in the flap to restore sensory sesation after transection.The wound in the donor site was closed in in-tradermal suture primarily.Postoperative algesia,touch,temperature sensation,Weber test of flap were tested and reco-rded.The critia of follow-up in this study were donor site morbidity,abnormal sensations,functional outcomes and sat-isfaction.Results The success rate was 100 percent in the series cases.The average length of follow up was 35 months (range,24 to 41 months).The wound in recipient area healed primarily and flaps showed no pigmentation but fine overall appearance,texture,and elasticity.The functional recovery of protective sensation was S3+ in 4 cases,S3 in 6,S2 in 2.Patients with liner scar in donor site were higly satisfied with the flaps for the sake of no significant joint functional outcomes.In terms of sensory sesation,the excellent and good rate of flap reached to 83 percent.Conclusion The free arm lateral flap represented a constant vascular anatomy,rich blood supply.Easy dissection,pliable texture,skin colour close to dorsum of hand and the possibility to be innervated through the posterior cutaneous nerve of the arm acceptable donor side morbidity provide a good option for the reconstruction of cutaneous defects of opisthena.