Application of bilobed flaps based on the supracarpal cutaneous branch of ulnar artery in digital reconstruction

Abstract

Objective To explore the surgical method of applying the bilobed free flaps pedicled with the supracarpal cutaneous branch of ulnar artery to repair digital defects and report the clinical outcomes. Methods From May 2010 to May 2013, the bilobed free flap pedicled with the supracarpal cutaneous branch of ulnar artery was transplanted to repair skin defect on fingers. Eleven patients suffering from traumatic digital defects with complicating tendon and phalanx exposure were retrospectively hospitalized for treament in Xuzhou Renci Hospital. There were 11 cases in this group, including 7 male and 4 female cases, age 19-43 years old. Seven cases of crush injury machine, avulsion in 3 cases, 1 case of electric saw injury. The time between injury and operation was 2.5 hours-8 days; wound ranged from 2.0 cm×5.5 cm to 6.0 cm×9.0 cm. Main outcome measures included patient's self-assessed physical appearance, total active motion(TAM), and two-point discrimination(2-PD). Results The flaps survived and the wounds healed by primary intention in all patients except one who experienced partial flap necrosis of the distal margin and required skin grafting. All patients were followed up for a mean of 13.8 months. The physical appearance and texture of the repaired fingers were assessed as good with minimal scarring. The TAM and 2-PD were 130°-265°(contralateral, 255°-270°) and 6.0-10.5 mm(contralateral, 3.5-7.0 mm), respectively. The hand health status was patient-rated as good. Conclusions The use of the bilobed free flaps pedicled with the supracarpal cutaneous branch of ulnar artery is a feasible, effective, and safe treatment alternative for repairing complex digital defects with favorable aesthetic and motor-sensory outcomes. Key words: Surgical flaps; Ulnar artery; Perforator; Finger injuries; Surgery, plastic