Repair of large area skin defect of forearm with overlength thoracic umbilical conjoined perforator flap with double blood supply

Abstract

Objective To explore the surgical method and clinical effect of repairing the large area skin defect of forearm with the perforator flap pedicle with the inferior epigastric artery perforator and the lateral cutaneous branch of the posterior intercostal artery. Methods From January, 2006 to January, 2016, 14 cases of forearm large area of skin defects were treated with the overlength flap at one stage. The proximal flap to the inferior epigastric artery umbilical perforation and the flap distal to the posterior interphalangeal artery perforation were used for the blood supply of superficial flap. The length of the flap was 25-43 cm (average, 36 cm) . The width of the flap was 5-14 cm (average, 9 cm) . All patients were followed-up regularly. The content of the follow-up included three aspects: appearance, hand function and the recovery of the donor site. Results Twelve cases of postoperative flaps successfully survived. Arterial crisis was seen in 1 flap 28 hours after surgery. The re-surgical exploration was adopted after conservation treatment for 1 h without remission and the proximal anastomotic flap embolization was confirmed. The flap survived. Venous crisis was seen in 1 case. The flap survived with the help of removing the suture, smoothing drainage and bleeding for 5 d. The wounds and the donor site of the thoracic and abdominal region healed at the first stage. The follow-up time was 8-72 months, with an average of 31 months. The flaps had no obvious bloated, the skin texture was close to forearm skin and the flaps were restored protected sensation. There was no ulceration, infection and other complications. The healing of skin graft was satisfactory in 2 cases in abdominal donor site. No skin graft contracture occurred. The remaining 12 cases had linear scar in the abdomen of the donor site. The edge of the scar was soft and no obvious contracture occurred. Conclusion Super long thoracic umbilical conjoined perforator flap can repair the lager area skin defect of forearm with double blood supply. The length of flap is significantly longer with enough-blood-supply of distal part of the flap. The clinical efffect is satisfactory. Key words: Conjoined flap, perforator flap; Inferior epigastric artery; Posterior intercostal artery; Forearm; Defects