Free perforator flaps for soft-tissue coverage of the hand

Abstract

Objective To evaluate the clinical outcomes of soft-tissue coverage of the hand using perforator flaps. Methods From May 2013 to September 2015, 10 cases of soft-tissue defects of the hand were treated with 12 free perforator flaps. These included 3 ulnar artery dorsal wrist perforator flaps, 1 proximal ulnar artery perforator flap, 2 dorsal interosseous artery perforator flaps, 1 medial arm perforator flap, 1 superficial iliac circumflex artery perforator flap, 2 anterolateral thigh perforator flaps and 2 medial sural artery perforator flaps. There were 3 cases of flow-through perforator flap, 2 cases of microdissected thin perforator flap and 1 case of lobulated perforator flap. The defects were located in the fingers in 6 cases, in the palm in 2 cases, and on the dorsum of the hand in 4 cases. The minimum size of the perforator flap was 5.0 cm×2.5 cm, while the largest was 11.0 cm×11.0 cm. Results All 12 perforator flaps survived uneventfully. No vascular crisis occurred. The color as well as texture of the flaps was satisfactory. There was no flap bulkiness. Only linear scar was seen at the donor site. Postoperative follow-up ranged from 3 to 15 months (8 months on average). Protective sensation was restored in some of these flaps. The function and appearance of the hand were good. Conclusion Free transplantation of perforator flaps causes less damage to the donor site and the hand, conforming to the principles of hand reconstruction. Perforator flaps of the upper limb are located close to the hand, with matching color and texture. It is an ideal option for repairing small to medium size soft-tissue defects of the hand. Key words: Surgical flaps; Hand injuries; Free transplantation; Soft tissue defects