Application of reversed island flaps based on the superficial palmar branch of the radial artery to reconstruct the first web

Abstract

Objective To discuss the clinical results of the island flaps based on the superficial palmar branch of the radial artery(SPBRA) in repairing the first web. Methods The clinical data of 8 hospitalized patients with soft tissue defect of the first web treated in Xuzhou Renci Hospital from 2012 January to 2013 March were analyzed retrospectively. There were 5 males and 3 females with aged 15-62 years. The defects, among which open wound in 5 patients, after the first web contracture released in 3 patients, ranged from 2.5 cm×3 cm to 3.5 cm×7 cm(mean 3.1 cm ×4.8 cm). The defects were treated with the retrograde island flaps based on the SPBRA. The donor sites were sutured directly. To observe the survival of skin flap, the wound healing after operation, follow-up observation of skin flap and the function of the first web and donor sites. Results In the 8 patients, 1 patient with intraoperative vascular variation, diverted to other operation, the other 7 patients were successfully completed the operation. All flaps survived completely. The wound and the donor area were healed by first intention. All patients were followed up 6 to 13 months, average 9.5 months. Appearance, consistency, and sensation of the flaps were satisfied. The thumb could complete the abduction and opponens function, donor scar slightly. The width of the first web ranged from 5.2 cm to 6.1 cm, average 5.8 cm, with the contralateral 72%-96%, average 87%. Thumb reconstruction function evaluation: excellent in 5 patiens, good in 1 patient, medium in 1 patient, the excellent and good rate reached 85.7%. Wrist function of donor site assessment: excellent in 6 patients, good in 1 patient. Conclusions With reliable blood supply, easy dissection, less injury at donor site and good repair results, the reversed island flap based on the SPBRA is an ideal flap for the reconstruction of the first web. Key words: Surgical flaps; Soft tissue injuries; First web; Island flap; Superficial palmar branch of radial artery