The application of free superficial circumflex iliac artery perforator flap in the coverage of upper extremity wounds

Abstract

Objective To investigate the clinical efficacy of using the free superficial iliac circumflex artery perforator flap to repair skin and soft tissue defects of the upper extremity. Methods Twenty-two cases of skin and soft tissue defects of the upper extremity treated between January 2008 and November 2015 were involved in this study. Among them 6 cases had forearm skin defects combined with tendon or bone exposure, 3 had skin defects around the wrist combined with tendon exposure, 10 had skin defects on the dorsum of the hand with exposure of extensor tendons, and 3 had dorsal finger skin defects with extensor tendon exposure. The size of the skin defects ranged from 3 cm×5 cm to 7 cm×15 cm. Vascularized free iliac circumflex artery perforator flap measuring 4 cm×6 cm to 8 cm×16 cm was used to repair these defects. The external oblique aponeurosis was included in the flap to reconstruct the extensor tendon defect in the finger in 3 cases, who had splint immobilization for 3 weeks before rehabilitation began. Results Intractable vascular spasm due to small caliber of the anastomosed superficial iliac circumflex artery occurred in one case that caused insufficient perfusion and flap necrosis. The wound was covered with local flap transposition. The rest 21 flaps survived uneventfully. The 21 patients were follow-up for 6 to 24 months. Flaps that covered the arm, wrist and dorsum of the hand had good appearance and texture. There was no need for flap debulking surgery. The results were satisfactory. The fingers that had flap transfer and extensor tendon reconstruct were slightly bulky, affecting finger extension and flexion. Conclusion The superficial circumflex iliac artery perforator flap is located in a hidden area of the body. Its blood supply is constant. The flap can be fully utilized. It is one of the ideal flaps for repairing soft tissue defects of the forearm, wrist and dorsum of the hand. Key words: Surgical flaps; Upper extremity; Superficial circumflex iliac artery perforator flap; Repair