Chimeric flap pedicled with the palmar branch of the radial artery from the wrist crease area for repairing complex tissue defect of the thumb

Abstract

Objective To investigate the surgical method and clinical effect of chimeric flap pedicled with the palmar branch of the radial artery from the wrist crease area for repairing the complex defect of the thumb. Methods Data of 11 cases with thumb complex tissue defects admitted during June 2013 to June 2015 were retrospectively analyzed. There were 7 males and 4 females, aged from 16 to 56 years, with an average age of 31.5 years. The soft tissue defect of the affected finger ranged from 3.0 cm×1.3 cm to 6.3 cm×2.0 cm, and the bone defect ranged from 1.3 cm×0.8 cm×0.4 cm to 2.8 cm×1.3 cm×0.8 cm. All the cases were repaired by chimeric flap pedicled with the superficial palmar branch of radial artery of the wrist crease area. The chimeric flap was transferred through the thenar part of the subcutaneous tunnel to the thumb surface to repair the defect of the composite tissue. The flap area ranged from 4.0 cm×1.5 cm to 7.0 cm×3.0 cm and the bone flap size ranged from 1.5 cm×1.0 cm×0.5 cm to 3.0 cm×1.5 cm×1.0 cm. The function of the finger was evaluated postoperatively according to the upper extremity functional tentative evaluation criteria of thumb and finger reconstruction by Hand Surgery of Chinese Medical Association. Results All 11 cases of wrist transverse bone flap survived. The average healing time of the bone flap was 1.6 (range, 1.5-3) months, and the bone graft was not absorbed. The function and appearance of the finger was good with only a linear scar; 6 months after surgery, the two-point discrimination on average was 7.1 mm (range, 5.5-9.0 mm). At the latest follow-up according to the upper extremity functional tentative evaluation criteria of thumb and finger reconstruction by Hand Surgery of Chinese Medical Association, finger function were excellent in 9 cases, good in 1 case, with the excellent rate of 90.9% (10/11). Conclusion The chimeric bone flap pedicled with the superficial palmar branch of radial artery can repair skin, soft tissue and bone defects of thumb simultaneously. It has the advantages of simple operation, safe blood supply, speeding up fracture healing, good functional recovery and concealed scar in donor area. It is a new choice to repair the complex tissue defect of thumb. Key words: Finger injuries; Surgical flaps; Microsurgery