The application of Iow-molecular-weight heparin in the distally based fascial flap

Abstract

Objective To evaluate the effect of low-molecular-weight heparin in the distally-based fascial flap to reduce venous congestion and increase flap survival quality. Methods From March 2007 to June 2009, 13 patients were treated with distally-based dorsoradial nerve fasciocutaneous flap for coverage of wounds of the thumb. The flap area was about 1.7 cm× 2.0 cm to 3.0 cm× 4.5 cm. Vascular pedicle length was about 1.5 cm to 3.0 cm. According to the order of the surgery, the patients were divided into two groups. Conventional treatment was given to the patients in group A, while in group B low molecular weight heparin was subcutaneous injected 5 000 IU once a day for 5 days. Blood circulation of the flaps was observed postoperatively. Results Blood circulation of the flaps was good in the early postoperative stage. After 1 to 2 days, blood oozing from flap edges stopped in group A. Three flaps began to appear obviously swelling. The color of the distal flaps turned dark purple. Removal some of the stitches, full-thickness incision on the flap and repeated draining dark red congested venous blood gradually turned the color of the flaps pink. All flaps survived eventually. In group B the bleeding time of the flaps were significantly longer than that in group A, and no flap showed obvious venous congestion or swelling. All the flaps survived with good quality. Three week to 2 months follow-up showed normal skin color, soft flap texture and good thumb movement. Conclusion The application of low-molecular-weight heparin can improve the microcirculation within the flap and increase the quality of flap survival after subcutaneous injection through increasing bleeding of flaps to release venous congestion of the flaps. Key words: Surgical flaps; Heparin,low-molecular-weight; Finger injuries