Flow-through forearm flaps in palmar finger reconstruction

Abstract

Objective To report the treatment and outcome of two kinds of flow-through forearm flaps in repairing palmar digital skin and artery defects. Methods The study included 15 patients (15 fingers) with palmar digtial skin combined with digital artery defects hospitalized from September 2011 through February 2014. Cut injuries were noted in 6 patients, crush injuries in 5 patients, and chain saw in 4 patients. There were 11 fingers with poor blood supply to the distal area and 4 no blood supply. One-stage reconstruction of the finger composite tissue defects was performed with flow-through free flaps including arterialised venous flaps (AVF) in 9 patients and superficial palmar branch of the radial artery (SPBRA) flaps in 6 patients. Discriminative sensation on the flap and active range of motion of the injured finger were analyzed and compared between the two groups. Results All the flaps survived and blood circulation in the finger restored. In AVF group, blister developed in 4 patients but healed within 5-10 days with no special care. Other than this the wound healed by the first intention. At a follow-up of 8-12 months, all the flaps that survived exhibited good restoration of the appearance, texture, thickness and protective sensation and the finger function was restored. According to the replanted finger function scoring system of Society of Hand Surgery of Chinese Medical Association, there were 6 excellent, 2 good, and 1 poor results in AVF group, with the excellent-good rate of 89%; there were 4 excellent, 1 good, and 1 poor results in SPBRA group, with the excellent-good rate of 83%. At postoperative 12 months, the two-point discrimination of the flaps was 6-9 mm[(7.6±1.3)mm] in AVF group versus 7-11 mm [(8.5±3.1)mm] in SPBRA group (P>0.05). Total active motion (TAM) of the injured fingers was (196.9±0.6)° in AVF group and was (196.2±0.5)° in SPBRA group (P> 0.05). Conclusion SPBRA flaps and AVF are both effective to cover digital wounds and restore blood circulation by flow-through technique. Key words: Surgical flaps; Soft tissue injuries; Fingers; Flow-through technique