Application of free ilioinguinal flap for repair of hand skin and soft tissue defects

Abstract

Objective To investigate the clinical effect of individualized free ilioinguinal flap in repairing hand skin and soft tissue defects. Methods From January 2013 to December 2017, 97 cases of hand skin and soft tissue defects were treated with free ilioinguinal flap. There were 63 cases of superficial circumflex iliac artery flap (26 cases of superficial circumflex iliac artery flap with iliac bone), 15 cases of superficial abdominal artery flap and 19 cases of combined flap of superficial circumflex iliac artery and superficial abdominal artery (7 cases of lobulated flap). The area of skin defects ranged from 4 cm×6 cm to 11 cm×23 cm. During the operation, end to end anastomosis of flap artery and the end branch of radial artery in 5 cases, end to side anastomosis of radial artery in 58 cases, end to side anastomosis of ulnar artery in 20 cases, end to side anastomosis of common digital artery in 14 cases. All the superficial circumflex iliac veins and superficial abdominal veins were repaired (a concomitant vein were repaired at the same time in 31 cases). The donor site was sutured directly after flexion of hip and knee without skin grafting. Three weeks, 1.5 months, 3 months, 6 months, 1 year and 2 years after the operation, the healing of donor area and the appearance and sensory recovery of recipient area skin flaps were observed. Results Postoperatively 94 cases survived successfully. Arterial crisis occurred in 1 case and venous crisis in 2 cases. 2 cases received surgical exploration and 1 case received conservative treatment. After that, 1 case survived smoothly and 2 cases suffered skin necrosis. Subcutaneous soft tissue survived after secondary escharectomy and survived after skin grafting. In one case of abdominal donor site, the incision dehiscence occurred in the first week of walking upright after operation, and healed after secondary suture. The remaining donor sites achieved primary healing. The follow-up period ranged from 0.5 to 1.5 years. The flaps were soft and slightly swollen, and the sensation returned to S2 or S3. There were only linear scars in the abdominal donor site. Conclusion According to the skin and soft tissue defects in the recipient area of the hand, the individualized free ilioinguinal flap transplantation can meet the different needs of the recipient area. The donor site is concealed, the cutting area is large, and it can be directly sutured. It belongs to the axial skin flaps. The blood vessels are constant, the cutting is convenient, the main blood vessels are not destroyed, and the operation time is short. Therefore, it is one of the ideal methods to repair the skin and soft tissue defects of limbs. Key words: Hand injuries; Surgical flaps; Skin and soft tissue defects; Free; Individualized