Soft Tissue Defects Of Hand Research Articles

Clinical analysis of repairing the defect of hand with reverse island skin flap of upper carpal cutaneous branches of ulnar artery

To investigate the clinical effect of repairing soft tissue defect after hand wound using reverse island skin flap of upper carpal cutaneous branches of ulnar artery. From June 2010 to November 2016, 12 patients with hand soft tissue defects were repaired by reverse island skin flap of upper carpal cutaneous branches of ulnar artery, including 9 males and 3 females with an average age of (35.2±9.4) years old ranging from 22 to 58 years. The defect area varied from 7.0 cm×3.0 cm to 12.0 cm×7.0 cm. Time interval from injury to operation ranged from 3 to 15 days with an average of (8.4±2.6) days. The flap was designed beforehand according to the size of the defect, sharply dissected the aponeurotic fascia from the proximal to the distal, abscised the communicating branch between the flap and the ulnar artery at the wrist epithelial branch, repairing the defect of flap with method of metastasis retrograde. The sensation, shape of the flap and hand function were observed, and the upper extremity function was evaluated according to the standard of hand surgery branch from Chinese Medical Association to assessment of functional recovery. The flaps in 10 patients obtained primary healing, the healed time was 14 to 18 days with an average of(15.0±1.5) days. Two patients occurred distal flap necrosis, and wound surface healed after change dressing and skingrafting cover. All patients were followed up from 3 to 15 months with an average of(7.0±3.8) months. According to the upper extremity functional evaluation standard by hand surgery branch of Chinese Medical Association, 2 cases got excellent results, 7 good, 2 fair and 1 poor. Reverse island skin flap of upper carpal cutaneous branches of ulnar artery for the treatment of soft tissue defect caused by hand wound has advantages of concealed donor area, no need sacrifice the main blood vessel, flap thin and no need repair it for thick and thin.

Adipofascial Posterior Interosseous Reverse Flap for Soft Tissue Loss on Dorsal Aspect of the Hand

Soft tissue defects of hand should be carefully evaluated to determine the most appropriate alternative for coverage. Thirteen patients with soft tissue loss on dorsum of the hand were managed by reversed septo fascial Posterior Interosseous Artery (PIA) forearm flap. The largest size of the defect was 120x50 cm all the flaps survived. The donor site was closed primarily. The flaps contoured well to the recipient site and had good cohesion and color match. The reversed posterior interosseous flap is a versatile and reliable alternative for coverage of moderate sized defects of the hand.

Application of bipedicled massive cross arm flap with dual blood supply for repair of forearm soft tissue defects

Objective To introduce a procedure and application of bipedicled latissimus dorsi and thoraco umbilical flap with dual blood supply, and to discuss the operative indication and key technology of massive long narrow flap for repair of forearm soft tissue defects. Methods From January 2009 to December 2011, 3 patients with forearm and hand soft tissue defects were treated by bipedicled latissimus dorsi and thoraco umbilical flap with dual blood supply. The flap area ranged from 25 cm×12 cm to 42 cm×10 cm. Double sets of arteriovenous were applied. The dorsal thoracic artery and vein were anastomosed to the ulnar or radial proximal artery and vein of the forearm, respectively, at the proximal of flap. The inferior epigastric artery and vein were anastomosed to the contralateral radial artery and vein, respectively, at the distal of flap. Both arms were fixed crossly. The distal pedicle was separated from contralateral upper limb 3 weeks after the operation. Results Three cases of flap all survived with upper limb retention. All the patients were follow-up for 8 to 36 months. Flap color, texture and forearm shape were good. Wrist and hand function partially recovered. The protective sensation of the flaps also recovered. Conclusion According to the principle of latissimus dorsi muscle and thoracic umbilical flap combined with double segment arterial blood supply, it can be designed as a huge long and narrow flap. It is a practical surgical method for repair of upper limb large soft tissue defects due to large area cutting, surgical safety and minor damage to donor sites. Key words: Surgical flaps; Forearm injuries; Double blood supply

The use of innervated radial artery superficial palmar branch perforator free flap for complex digital injuries reconstruction

Loco-regional flaps have been widely used for the reconstruction of digital injuries without requiring microvascular anastomosis, however, they result in scarring and compromised functional outcomes. This study demonstrates our experience utilizing the innervated radial artery superficial palmar branch (RASPB) perforator free flap for complex digital injury reconstruction. From May 2007 to March 2014, the innervated RASPB perforator free flap was used to reconstruct 79 distal complex hand and digital soft tissue defects of which 14 were used to re-vascularise the distal digit in a flow-through fashion. All free flaps were innervated by the palmar cutaneous branch of the median nerve. All 79 free flaps survived and all 14 digits re-vascularized successfully. One flow-through free flap developed distal skin necrosis which healed uneventfully without further procedure. The average follow-up was 21.5 months. Measurement of two-point discrimination ranged from 7 to 13 mm. All patients were satisfied with the aesthetic results. The innervated RASPB perforator free flap is a feasible and effective option for the reconstruction of complex digital defects and the flow-through concept, when utilized in cases with compromised vascularity, provides reliable re-vascularization. Level III, therapeutic study.

Risk factors for pedicled flap necrosis in hand soft tissue reconstruction: a multivariate logistic regression analysis.

Few clinical retrospective studies have reported the risk factors of pedicled flap necrosis in hand soft tissue reconstruction. The aim of this study was to identify non-technical risk factors associated with pedicled flap perioperative necrosis in hand soft tissue reconstruction via a multivariate logistic regression analysis. For patients with hand soft tissue reconstruction, we carefully reviewed hospital records and identified 163 patients who met the inclusion criteria. The characteristics of these patients, flap transfer procedures and postoperative complications were recorded. Eleven predictors were identified. The correlations between pedicled flap necrosis and risk factors were analysed using a logistic regression model. Of 163 skin flaps, 125 flaps survived completely without any complications. The pedicled flap necrosis rate in hands was 11.04%, which included partial flap necrosis (7.36%) and total flap necrosis (3.68%). Soft tissue defects in fingers were noted in 68.10% of all cases. The logistic regression analysis indicated that the soft tissue defect site (P = 0.046, odds ratio (OR) = 0.079, confidence interval (CI) (0.006, 0.959)), flap size (P = 0.020, OR = 1.024, CI (1.004, 1.045)) and postoperative wound infection (P < 0.001, OR = 17.407, CI (3.821, 79.303)) were statistically significant risk factors for pedicled flap necrosis of the hand. Soft tissue defect site, flap size and postoperative wound infection were risk factors associated with pedicled flap necrosis in hand soft tissue defect reconstruction.

Free super-thin peroneal artery perforator flap containing neurovascular axis for coverage of hand or foot tissue defects

Objective To investigate the clinical results of free super-thin peroneal artery perforator flap containing neurovascular axis in reconstruction of hand or foot soft tissue defects. Methods A retrospective case series study was made on 23 cases of hand or foot soft tissue defects admitted from January 2006 to March 2013. There were 16 males and 7 females, with a mean age of 33 years (range, 17-51 years). Wounds were located in dorsal hand (n=12), dorsal pedis or amputated forefoot (n=8), greater thenar (n=2) and index finger (n=1) respectively. Defects ranged in size from 5.0 cm×3.5 cm to 11.5 cm×7.5 cm. Flap elevating was performed underneath the deep fascia and the perforator supplying the flap was dissected thoroughly, ligated and cut at the location arose from the peroneal artery. Most of the deep fascia except stripe shaped areas along the main blood supply chains was moved sharply and the fat underlying thinned primarily to the subdermal vascular network. After transferred to the recipient site, the flaps were revascularized by anastomosis of the perforating artery and its venae comitantes to appropriate recipient vessels. A total of 15 cases received innervated flap reconstruction. Flap vascularity and cosmetic results were recorded. Hand function was evaluated with the standard set up by the hand surgery branch of Chinese Medical Association. For foot reconstruction, shoe wearing status, gait, pressure-sore, flap sensibility, donor site appearance and complications were evaluated. Results All flaps were transplanted successfully with satisfactory cosmetic results, except that one flap used to cover dorsal ring finger defect left slightly bulky appearance. Mean duration of follow-up was 19 months (range, 11-26 months). For hand reconstruction, the functional results were excellent in 6 cases and good in 9 cases. Repairing of foot defects with the flaps caused no problem of shoe wearing and no sore occurred. Normal gait was acquired except two cases of partially amputated foot. If innervated, flap sensibility was restored at least to the degree of S3. Protective sensation and touch-pressure sensation were restored in eight non-innervated cases, and two of them were recovered to the degree of S3. There was only suture or small grafting scars on the donor leg and partially sensibility loss of lateral foot without functional defects in 13 cases. Conclusion Free super-thin peroneal artery perforator flap containing neurovascular axis is an easy and reliable technique that can attain satisfactory results for accurate coverage of hand or foot soft tissue defects. Key words: Surgical flaps; Hand injuries; Foot

Different modalities of soft tissue coverage of hand and wrist defects

Soft tissue defects of hand and wrist with exposed tendons, joints, nerves and bones represent a challenge to plastic surgeons. Such defects necessitate early flap coverage to protect underlying vital structures, preserve hand functions and to allow for early rehabilitation. Many flaps have been described and used for coverage of various soft tissue defects. Of these flaps, there are reversed flow flaps like reversed radial forearm flap, and reversed perforator forearm flaps. The distant flaps used in the reconstruction of hand and fingers are the groin flap, the abdominal flap, the abdominal pocketing procedure and free vascularised flaps. In our study, we used some standard flaps to cover the defects according to the flap availability and feasibilty.

Extensor Tendon and Coverage Reconstruction of Soft Tissue Defect in a Case of Trauma to Dorsal Hand

: A case of soft tissue defect of dorsal hand due to crush injury in a 37-year-old female is reported here. The reconstructive surgery was performed for the hand soft-tissue defect. Among different flaps used in the surgery, the regional flap such as radial forearm flap can be done. But usually it is not accepted by patient because of cosmetic appearance. Therefore, random pattern abdominal flap and extensor tendon reconstruction were done concurrently.

Management of soft tissue defects of hand with local (posterior interosseous) flaps

Design:-Observational case series study Objective: - To evaluate the role of Local Flaps in the management of the soft tissue injuries of hand. Suit &amp; Period: -. Study was conducted at BV Hospital, Bahawalpur from June 2002 to May 2003. Material &amp; Method: - In this study, we selected cases in which direct skin closure was not possible due to large defect or skin grafting was contraindicated for example in cases where bones and tendons were exposed, or in certain conditions where some secondary procedures may have to be carried out like tendon repair, tendon grafting nerve repair or fixation of fracture. Patients with severely crushed, non-salvageable hands, manageable with primary suturing &amp; skin grafts &amp; Patients with peripheral vascular disease, Elderly diabetic &amp; Patients medically unfit for anesthesia. Results: A total of 10 patients were treated between June 2002 and May 2003. There were 8 males and 2 females (male to female ratio 4:1). Mean age of the patients was 26.26 years with range between 10 and 60 years. Most common cause of skin defects was agriculture machine injury (6 cases) followed by roadside accidents (2 cases), blast injury (I cases), and electric burn (1 cases). In 7 patients there was an uneventful recovery. One flap was lost completely, partial flap loss occurred in one case, marginal necrosis and infection noted in one case. Conclusion: -Local (posterior interosseous island) flaps are useful for coverage of the skin defects over the hand when applied with proper indications.

Repair of soft tissue defect in hand or foot with lobulated medial sural artery perforator flap

To explore the clinical effect of the lobulated medial sural artery perforator flap in repairing soft tissue defect in hand or foot. Since March 2012 to September 2014, 6 cases with soft tissue defects in hands or feet were treated by lobulated medial sural artery flaps pedicled with 1st musculo-cutaneous perforator and 2st musculo-cutaneous perforator of the medial sural artery. The size of the flaps ranged from 4.5 cm x 10.0 cm to 6.0 cm x 17.0 cm. 5 cases of lobulated flap survived smoothly, only 1 lobulated flap had venous articulo, but this flap also survived after the articulo was removed by vascular exploration. All flaps had desirable appearance and sensation and the two-point discrimination was 6 mm in mean with 4 to 12 months follow-up (average, 7 months). Linear scar was left in donor sites in 3 cases and skin scar in 3 cases. There was no malfunction in donor sites. Lobulated medial sural artery perforator flap is feasible and ideal method for the treatment of soft tissue defect in hand or foot with satisfactory effect.

Reconstruction of hand soft tissue defects with dorsal interosseous artery island flap

Objective To evaluate the clinical effect of dorsal interosseous artery island flap to cover soft tissue defects of the hand. Methods Ten cases (8 males and 2 females) treated between 2009 and 2012 were included. The age was from 15 to 74 years. There were 4 patients associated with mechanical injury, 3 electric injury, 2 chronic ulcer and 1 hot crush injury. Size of the defect ranged from 3.0 cm×2.5 cm to 12.0 cm×7.0 cm, and the size of the flap ranged from 4.0 cm×3.0 cm to 13.0 cm×8.0 cm. The portable Doppler ultrasound was employed to locate the branches from the forearm dorsal interosseous artery. The dorsal interosseous retrograde artery distally based was used to repair hand soft-tissue defects. Results All the flaps survived except for some necrosis in one case which healed after dressing change. Eight patients were followed up for 3 months to 1 year and two patients were lost to follow-up. Flap had soft texture and similar color and sensation as the adjacent skin. No apparent hypertrophic scarring on the donor site was observed. Flap was slightly swollen in one case. Conclusion Dorsal interosseous artery retrograde island flap is safe and effective to repair hand soft tissue defects. Key words: Hand injuries; Arteries; Surgical flaps

Repairing of limb extremity wounds with free descending genicular artery perforator flap without saphenous vein

Objective To explore the surgical technique and the efficacy of free descending genicular artery perforator flap without saphenous vein for tissue defect. Methods 18 cases of extremity tissue defect were involved in this study from August 2010 to April 2014, including 16 males and 2 females with an average age of 32.4 years (8 plantar or heel soft tissue defect, 10 back of hand or palm soft tissue defect). 2 old injury cases that had soft tissue defect after scar release were treated by free flaps and the other 16 were open injury with infection, among which 5 cases were combined with fractures or bone defect. Sizes of the skin and soft tissue defect were 2.0 cm×8.0 cm to 9.0 cm×12.0 cm. All wounds were treated by free descending genicular artery perforator flap from the contralateral limb. Medial femoral cutaneous nerve was kept in flaps as far as possible. The projection points of descending genicular artery perforator and saphenous vein were detected by Doppler, then the flaps were cut with reverse approach, and saphenous vein and saphenous nerve were preserved. Results All 18 flaps were survived and all cases were followed up for 3 to 30 months (average, 10.3 months). The flap sizes varied from 2.5 cm×9.0 cm-9.5 cm×13.0 cm. 2 cases with bone defect were healed 3 months later without infection, and the other 3 cases with fractures were healed 2-3 months after operation. The two point's discrimination distance was 7.0-12.0 mm on the flap. The disabilities of the arm, shoulder, and hand questionnaire score averaged 51, and the mean Japanese Orthopaedic Association's foot rating scale was 70.5. Most patients were satisfied with appearance of the recipient and donor sites, among which 5 cases had skin-graft on the donor sites, and the other 12 cases had small scars on the donor sites. Poor healing was detected in 1 case on the thigh which was healed 3 weeks later. There was no paresthesia and rash on the donor sites. The mean distance between projection points of descending genicular artery perforator and saphenous vein was 3.7 cm. Conclusion Free descending genicular artery perforator flap without saphenous vein is an optimal therapy for the extremity tissue defect, which has the advantage of covert donor site, less invasion, less variation of perforator, and could recover the skin sense of recipient site. Key words: Surgical flaps; Wounds and injuries; Extremities

Free flap pedicled with peroneal artery perforator to repair soft tissue defects at hands and feet

Objective To explore the clinical effects of free flap pedicled with peroneal artery perforator in repair of soft tissue defects at hands and feet. Methods From July 2010 to December 2012, 36 patients with soft tissue defects at hands and feet were repaired by free flaps pedicled with peroneal artery perforator. They were 30 men and 6 women, 21 to 50 years of age (average, 32.6 years). Twenty-one pa-tients had skin defects at distal 1/3 dorsum of foot; of the 15 patients with hand soft tissue defects, 8 had skin defects and tendon exposure at dorsum of hand, 3 had skin defects between the thumb and the index finger, and 4 had skin defects and tendon exposure at the palm. The defective areas varied from 3.0 cm×2.0 cm to 8.5 cm×4.0 cm, the flap harvesting area varied from 4.0 cm × 3.0 cm to 10.0 cm × 5.0 cm. the time from injury to operation was from 3 to 78 hours (average, 12.8 hours). Twenty-nine flaps were pedicled with intramuscular perforating branches, and 6 with intermuscular perforating branches. The blood vessels were anastomosed end to end. The function of affected limbs in the 15 cases of hand soft tissue defect was evaluated at the last follow-up according to the criteria by Hand Surgery Society, Chinese Medical Association (HSSCMA); the 21 patients with soft tissue defect of the feet was evaluated according to criteria by Japanese Orthopaedic Association (JOA); the functional recovery of skin sensation in the 36 patients was evaluated according to the criteria by British Medical Research Council (BMRC). Results All the transferred free flaps survived uneventfully. The 36 patients were followed up for 6 to 24 months (average, 11 months). The flaps showed no pigmentation but fine texture, appearance, and wear-resistance. According to HSSCMA cri-teria, the function of affected limbs was excellent in 12 cases, good in 2 and fair in one. According to JOA criteria the 21 patients with soft tissue defect of the feet scored an average of 90.6 points (rang, from 80 to 98 points). According to BMRC criteria, the functional recovery of skin sensation was S3 to S4 in 25 cases, S2 in 9, and S1 in 2. The donor limbs showed no cicatricial contracture or dysfunction. Conclusions Free flaps pedicled with peroneal artery perforator are a good choice for repair of small or middle areas of soft tissue defect at hands and feet, because they are characterized by stable vascular anatomy, proper thickness, no damage to primary artery, slight injury to the donor site, and direct anastomosis. Key words: Surgical flaps; Soft tissue injuries; Hand; Foot

Composite transfer of the second toe and dorsal pedal trilobe flap for reconstruction of hand and thumb soft tissue defects

Objective To investigate the clinical outcomes of treating irregular tissue defect of the thumb and hand with composite transfer of the second toe and dorsal pedal trilobe flap.Methods From June 2010 to March 2013,6 cases of thumb injury with various degrees of thumb defect,skin defect at the palm,dorsum and web space,and exposure of tendon,bone and neurovascular structures were treated with composite transfer of the second toe and dorsal pedal trilobe flap.Results The trilobe flaps including the lateral tarsal flap,medial tarsal flap,dorsalis pedis flap all survived uneventfully.The transferred second toes survived as well.Wounds at the donor and recipient sites all achieved primary healing.The patients were follow-up for 3 to 18 months with an average period of 8 months.The shape,color and texture of the flaps were good.Function of the reconstructed thumb was satisfactory.Weight-bearing and walking with the donor foot was not affected.There was no ulcer in the flap donor site.Conclusion Combined transfer of dorsal pedal trilobe flap based on the anterior tibial artery vascular pedicle and the second can effectively reconstruct thumb defects complicated by irregular tissue loss.This method provides sufficient tissue coverage and reliable blood supply.It complies with principles of wound repair. Key words: Microsurgery; Surgical flaps; Anterior tibial artery; Second toe; Thumb reconstruction

Reconstruction of the Hand Soft Tissue Defects with the Free Proximal Posterior Interosseous Artery Perforator Flaps

Introduction: To investigate the applied anatomy of the proximal posterior interrosseous artery perforator flap (PIAP) and report the clinical results of repairing the soft tissue defects in hands&#65294

Repair of minor tissue defect in hand by transfer of free tissue flap from the toe.

To introduce our experience of using the free neurovascular flap from great and second toe. Thirteen patients (fifteen fingers) sought surgical treatment for soft tissue defects of the hand at our medical institution between March 2006 and September 2009. In two patients, fibular side skin-nail flaps of great toe were applied to cover the dorsal defect of distal thumb. In twelve, the treatment was carried out for the pulp defect of finger with fibular side flap of great toe or tibial side flap of second toe. In one, the treatment was carried out for the defect of distal middle with composite flap with distal digital bone of second toe. All flaps survived. The average subjective satisfaction score was 8.08 (range 4-10). Nine patients (69%) experienced cold intolerance, and 2 patients (15%) dysesthesia. The Semmes-Weinstein sensitivity score was between 3.47and 4.72 on the flap, and 0-4.18 on the donor site. The mean two-point discrimination was 6.8 mm (range 4-12). Grip strength was 10% less than in the unaffected hand. The proximal interphalangeal mobility loss was less than 15 degrees. Our results indicated that these free flaps from toe are useful for patients with a small soft-tissue defect in hand.

One-stage reconstruction of dorsal hand soft-tissue defects with tendon allograft and free anterolateral thigh flaps

Objectives To evaluate the clinical effect of one-stage reconstruction of dorsal hand softtissue defects using tendon allograft and free anterolateral thigh flaps.Methods From July 2006 to July 2011,fifteen cases of complex soft-tissue defects in dorsal hands were repaired using tendon allografts and anterolateral thigh flaps,sizing from 9 cm ×5 cm to 14 cm× 11 cm,in one stage.Two to 4 digital extensor tendons were reconstructed.With a brace on,early finger exercises were started after 2 weeks postoperatively when the flaps had survived.Results All the 15 flaps survived uneventfully.Twelve of the 15 patients were available for follow-up from 12-24 months (averaged 16 months).Two cases received tendolysis due to poor finger movement 6 moths postoperatively.At the end of follow-up,the range of wrist joint active flexion is from 40 to 70degrees and extension is from 25 to 50 degrees.The motion range of the related metacarpophalangeal joints was from 60 to 85 degrees,that of the interphalangeal joints from 80 to 90 degrees.The overall effective rate was 92 percent.Conclusion Simultaneous composite repair using tendon allografts and skin flaps proved to be reliable and cost-effective for complex dorsal hand soft-tissue defects.Allograft tendon reconstruction can not only obliterates new morbidities of autografting but also facilitates timely rehabilitation,avoiding extension loss of hand joints. Key words: Anterolateral thigh flap; Tendon allograft; Dorsal hand; Microsurgery

Anatomy of the free saphenous branch of descending genicular artery flap and its clinical application for the hand soft-tissue defects

Objective To provide anatomical basis for the free saphenous branch of descending genicular artery flap and evaluate its clinical outcomes for the hand soft-tissue defects. Methods Fifteen fresh cadavers injected with lead oxide-gelatin mixture for three-dimensional visualization reconstruction using a spiral computed tomography scanner. The origin, course and distribution of the perforators of descending genicular artery were observed.From January 2005 to October 2011,seven patients with skin defect on the distant limbs were treated.The flap size was 5 cm × 6 cm-11 cm × 14 cm,vascular pedicle length 5.4 (4-7)cm. Results The saphenous branch was consistent. It arised from the descending genicular artery (68％) or femoral artery(32％).The diameter of the saphenous branch was 1.5(1.1-1.7)mm at its origin above 9.0(4.0-16.0)cm from the medial epicondylar.Seven cases of flaps all survived,the average followup of 28 months,close to hand flap of skin texture,some sensory recovery,two-point discrimination 8-12mm. Conclusion Free saphenous branch of descending genicular artery flap is a reliable option for the treatment of soft tissue defect in hands. The pedicles were invariable of anatomy, thickness of the flaps is comparable,and procedure is simple and time saving. Key words: Descending genicular artery; Saphenous branch; Digital anatomy; Transplantation; Perforator flap

Multiple soft tissue defects of hand repaired by muliplefoliated tissue flap only pedicled by descending branch of lateral circumflex femoral artery

Objective To introduction of perforator flaps, muscle flaps pedicled by descending branch of lateral circumflex femoral artery, method and their clinical application that multiple soft tissue defects of hand are repaire by muliplefoliated tissue flap only branch lateral circumflex femoral artery.Methods Fifteen patients with multiple soft tissue defects of hand were repaired muliplefoliated tissue flap only pedicled by descending branch lateral circumflex femoral artery. At first, the anterolateral thigh perforator flap was designed and harvested according to the soft tissue defects of hand, then the descending branch lateral circumflex femoral artery was dissected at the same time the segmented perforator flap, fascia lata flap,rectus femoris muscle flap, vastus lateralis muscle flap, vastus intermedius muscle flap and distal spatium intermusculare flap were harvested in need according to distance among soft tissue defects. The muliplefoliated tissue flap was harvested only pedicled by descending branch lateral circumflex femoral artery, at last muscle flaps and fascia lata flaps were covered by skin graft, so the multiple soft tissue defects of hand were repaired in one time. Results No vascular crisis happened. All skin grafts survived well, the contour of all repaired soft tissue defects was good and protective feeling was recovered by skin grafts of all flaps. All cases were got follow-up and the range was from 6 to 20 months (the average was 8.7 months). Wound of donor site healed well, muscle strength of quadriceps and motion of knee were normal. Three cases were excellent,nine cases were well and 3 cases were good, according to upper extremity function evaluation criteria of Chinese Medical Society for the Surgery of the Hand, the rate of good was 80 percent. Conclusion Multiple soft tissue defects of hand can be repaired by muliplefoliated flap only pedicled by descending branch of lateral circumflex femoral artery. Its advantages included reduction of operation time and treatment, good recovery of hand contour and function. It is a good method to repair multiple soft tissue defects of hand. Key words: Hand; Lateral circumflex femoral artery; Tissue flap ; Microsurgery

Combined medialis pedis and medial plantar fasciocutaneous flaps based on the medial plantar pedicle for reconstruction of complex soft tissue defects in the hand

The reconstruction of complex soft tissue defects in hands remains a difficult challenge in reconstructive surgery. In this report, we introduce a combined medialis pedis and medial plantar fasciocutaneous flaps supplied by the lateral and medial branches of the medial plantar artery, which allows a one-stage reconstruction of multiple soft tissue defects in hand. Three combined medialis pedis and medial plantar fasciocutaneous flaps were transferred for repair of the soft tissue defects including palmar and dorsal areas of hand, thumb pulp, and the dorsum of index finger in three patients. All three flaps survived uneventfully with coverage matching the texture and color of the recipients. The donor sites healed without complication. The experience from these cases proves that the combined medialis pedis and medial plantar fasciocutaneous flaps based on the medial plantar pedicle would be a valuable alternative for the reconstruction of complex soft tissue defects in the hand.