Tissue Defects Of Hand Research Articles

Rehabilitative treatment of lower leg injury was studied by using anterolateral free thigh flap with CT scan

ObjectiveIn cases of severe soft tissue loss and deep tissue exposure in the lower part of the leg, microsurgical skin flap transplantation is the primary treatment method. MethodsBased on the anatomy of the descending branch of the lateral circumflex femoral artery and its musculocutaneous perforators, a free, ultra-thin anterolateral thigh perforator flap is designed for the repair of soft tissue defects in hands and feet. This method has been successfully used at our hospital to treat three patients. Postoperative recovery was favorable, with no vascular crises, and all skin flaps survived. ResultsThe aesthetic appearance of the repaired area was approved by patients, and there were no severe complications post-surgery. Patients were followed up for a period ranging from 6 to 24 months, averaging 14 months. The skin flaps were soft and elastic, without swelling, and the color matched that of normal skin, with good sensory function recovery. ConclusionIn surgical treatment of lower leg wounds, prioritizing using a free anterolateral thigh flap can enhance the repair of the wound and expedite functional recovery postoperatively.

Pedicled Groin Flap for Coverage of Soft Tissue Defect of Hand

Background: Distant pedicle flaps like groin flaps are still considered workhorse flaps for the coverage of soft tissue defects of the hand. In the era of free flaps pedicle flaps are still considered as primary flaps by many surgeons. Pedicle flaps are easy to raise, require less experience and microsurgical facility. Methods: In this retrospective descriptive study, patients in whom groin flap was done for reconstruction of hand soft tissue defects were included from April 2017 to April 2022. Results: Thirty-three flaps were included in this study with an average patients’ age of 34.6 years. There were 24 males and 9 females. All flaps survived and served the purpose of covering wounds. Complications like finger and shoulder stiffness were seen in 18 (54.5%), partial necrosis was seen in 4 (12.1%), marginal necrosis in 2 (6%), and infection was seen in 5 (15.2%) patients. Donor sites were healthy after insetting of the flap and did not show any sign of morbidities like infection or bad scarring. Conclusion:Groin flaps are versatile flaps. Where microvascular free flaps are not possible due to severity of injury or due to unavailability of the facility for microvascular free flap groin flap is an excellent option. With less complication, those flaps can be executed easily.

Reconstruction of soft tissue defects of hand: A systematic approach.

A thorough insight into the management of hand injuries can shape the approach of a surgeon in order to achieve optimal outcomes for the patients. The aim of this study was to share our experience in reconstruction of the hand and establishing an algorithm for classification and treatment of hand injuries. This is a descriptive cross sectional study and was conducted from January 2020 to August 2022 at Burns and Plastic Surgery center, Peshawar. Data was collected from medical records about the patient demographics, mechanism of injury and type of procedures done. Defect size was classified into small (<5cm), medium (5cm to 10 cm) and large (>10cm). The defect site and size was cross tabulated against the method of soft tissue reconstruction in order to make the algorithm for reconstruction of hand injuries. Data was analyzed using SPSS. The study population included 41 (75.9%) male and 13 (24.1%) female patients, mean age 31.56±14.1. Machine injuries (33.3%) and electric burns (24.1%) were the most common cause of hand soft tissue defects. The most commonly performed flap was Posterior introsseous artery (PIA) flap, followed by First dorsal metacarpal artery (FDMA) flap. Flap necrosis was observed in three cases (5.6%). This treatment algorithm for coverage of soft tissue defects in hand injuries will help with the decision making process of hand reconstruction and has didactic value for novice surgeons. It will also form the foundation for further work on this aspect of hand injuries.

Retracted: Clinical Application of Artificial Dermis and Autologous Skin in Repairing Skin and Soft Tissue Defects of Hands and Feet with Bone Exposure Injuries.

[This retracts the article DOI: 10.1155/2021/1202826.].

Assessment of Flap Viability and Post-operative Hand Function After Resurfacing of Acute Soft Tissue Injury onthe Palm of Hand byGroin Flap and Reverse Pedicled RadialForearm Flap

Background: Many flaps have been described and used for coverage of various soft tissue defects of hand, which can be regional or distant. Objective: In this study main goal is to evaluate the assessment of flap viability and post-operative hand function by Total Active Motion (TAM) and Hand grip strength. Method: This was a comparative observational study, conducted at department of Orthopaedic Surgery and Burn and Plastic surgery in Sylhet MAG Osmani Medical College Hospital (SOMCH) from January 2018 to October, 2019. A total of 16 patients with acute hand injury or pathology in the palm which may create surgical wound, admitted in the study place during the study period were the study population. Where those who had Acute wound in palm with exposed tendon, nerve and bones or degloving hand injury were included in the study. Patient were divided into two group namely Group-A and Group-B. Patient chosen for groin flap were allocated in group-A and for reverse pedicled radial forearm flap were in group-B. Results: During the study, complete flap survival was 100% in both group A and B. At all the follow-ups hand grip strength was more in group B and the difference was statistically significant (p&lt;0.05, obtained by unpaired t-test). At final follow-up (12 weeks) hand grip strength was 22.38 (SD±5.26) kg in Group A and 30.13 (SD±10.15) kg in Group B.There is no(0.0%) excellent result of index and middle finger in group A patient compared to 3 (37.5%) and 6 (75.0%) patients respectively in group B. Ingroup A3 patient had excellent outcome in ring fingercompared to 7 (87.5%) patients in group B. Majority (87.5%) patient‘s little finger was excellent in group A and 8(100.0%) in group B.The difference of index finger and middle finger were statistically significant between groups (p&lt;0.05 obtained by Fisher Exact test). Conclusion: From this study we can say that, both the handgrip strength and TAM score was better in patients who underwent radial forearm flap and the difference was statistically significant (p&lt;0.05). It is concluded that reverse pedicled radial forearm flap has better outcome regarding flap viability and post-operative hand function than groin flap.

Usefulness of Reverse Radial Forearm Flaps in Covering Soft Tissue Defects of Hand and Wrist

Aim: To emphasize on the importance of reverse radial forearm flap (RRF flap) in the coverage of soft tissue defects of hand and wrist. Study design: This is a descriptive experimental study. Study place and duration: Study was comprised on the period of six months from January 2022 to June 2022. It was conducted in the plastic surgery department of Allama Iqbal Memorial Teaching Hospital Sialkot Methodology: Patients with the soft tissue defects of hand and wrist due to road traffic accidents, industrial or mechanical trauma and firearm injury were admitted to the plastic surgery ward. After achieving healthy wound with wound debridement, soft tissue coverage was done using reverse radial fasciocutaneous forearm flap. Patients with amputation of thumb and those with partial or complete bone loss were excluded from the study. Ages of the patients were 17-50 years with mean age of 31.42±5.3 years. Donor site of the flap was covered with split thickness skin graft and follow-up of the patients was done for at least three months. Results: 20 cases were included in this study including 16(80%) male and 04(20%) female cases. 15(75%) cases had soft tissue defect on the dorsum of hand, 04(20%) cases had palmar defect and in 01(5%) case there was amputation at transmetacarpal level and flap coverage of the stump was done. Partial loss of the flap happened in one 01(5%) case and it was treated with debridement and skin coverage. In one case superficial epidermolysis was found and managed conservatively. Practical implication Conclusion: Reverse radial forearm fasciocutaneous flap is an excellent option for the coverage of soft tissue defects of hand and wrist due to its greater arc of rotation which makes it easy to apply to the recipient site. Key words: Hand trauma, Soft tissue defects of hand, Reverse Radial Forearm Flap, Flap Coverage of Hand

Versatility and reliability of reverse posterior interosseous artery flap for coverage of soft tissue defects of hand and wrist.

Objective: To evaluate reverse PIA flap in reconstruction of various types of soft tissue defects of the hand in terms of reliability, flap survival, total duration of hospital stay, patient’s satisfaction and duration of return to work Study Design: Case Series study. Setting: Jinnah Burn and Reconstructive Surgery Center, Lahore. Period: January 2018 to July 2020. Material &amp; Methods: Twenty three posterior interosseous artery flaps were used for coverage in patients who had soft tissue defects over hand dorsum, wrist and first web space. Both sexes were included with age group ranging between 15 to 60 years. Results: Twenty two flaps, out of total 23 survived completely. In one patient, there was partial flap necrosis for which skin grafting was done. Donor sites were successfully covered with skin grafts. All patients went on to resume their work within a month or two and were quite satisfied with aesthetic outcome. Conclusion: A well planned reverse PIA flap is not only a safe, versatile and reliable option for coverage of hand defects but also entire has the benefit of a shorter hospital stay, allowing early return of patient to work and superior aesthetic outcome.

Reconstruction of the soft tissue defects of hand and wrist with ulnar artery perforator flap-presentation of case series

Reconstruction of soft tissue defect of hand and wrist is a common problem to plastic surgeon. I reconstructed the defect, both dorsal and palmar surface with a perforator-based flap from ulnar artery. The aim of the present study is to evaluate ulnar artery perforator flap in soft tissue defect of hand and wrist. Between January 2018 to February 2021, seven cases of skin defect were reconstructed with a perforator-based flap from ulnar artery, either pedicled or propeller type flap. The study was done at NRS medical college, Kolkata, where I have evaluated the viability of the flap, post-operative complication and patient’s satisfaction. All flaps survived, only in one case there was marginal necrosis that was treated conservatively. There was no post-operative complication, all flaps were doing well in six month and one year and one and half year follow up and patient’s satisfactions were also good. Ulnar artery perforator based fasciocutaneous flap, pedicled or propeller provides a reliable coverage of soft tissue defects of hand as well as wrist.

RECONSTRUCTION OF UPPER EXTREMITY DEFECTS WITH DISTANT PEDICLED FLAPS

Objective Pedicled abdominal and inguinal flaps have been used for hand and forearm reconstruction for years. Nowadays they are applied as a safe option when free flap is not suitable. In this study, we aimed to present cases in which soft tissue defects on hand and forearm were closed with pedicled groin and abdominal flaps, in the light of the literature. Materials and methods Thirty-five patients whose soft hand tissue defects in the hand and forearm were treated with pedicled groin and abdominal flaps in the department of Plastic, Reconstructive and Aesthetic Surgery between 2010 and 2022 were included in the study. Data such as age, gender, cause of defect, localization of defect, size of defect, donor site closure method, flap division time, hospitalization time and complications which were obtained from patient files were evaluated. Results Our patients were between the ages of two and 65 and mean age was found as 33.9 ± 15,7. Thirty-one (88.5%) of our patients were male, while four (11.5%) were female. When the causes of defects were examined, it was found as crush injuries of hand and fingers in 12 patients (34.29%), electrical burn in 11 patients (31.43%), gunshot wounds in five patients (14.28%), degloving injury in four patients (11.43%) and snake bite in three patients (8.57%). All flap donor sites were closed primarily. Flap loss was not recorded. Conclusion Pedicled abdominal and inguinal flaps, which are a fast and safe option, continue to be an important alternative in suitable patients despite the advances in microsurgery.

Clinical effects of bridge-type continuous negative pressure suction in postoperative fixation of upper limb soft tissue defect wound repaired with pedicled abdominal flap

Objective: To observe the clinical effects of bridge-type continuous negative pressure suction in postoperative fixation of upper limb soft tissue defect wound repaired with pedicled abdominal flap. Methods: The retrospective observational study was conducted. From April 2018 to October 2020, ninety-five patients who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University, including 55 males and 40 females, aged 5-78 years, with a defect wound area of 82 (9, 216) cm2. All patients underwent abdominal flap repair for soft tissue defects of hand and forearm. According to the different fixation methods adopted in the operation area, the patients were divided into negative pressure group (n=48) and plaster group (n=47). Wounds of the injury sites of patients in the 2 groups were repaired by flap transplantation after debridement. The negative pressure suction device was placed after dry gauze dressing to form a "bridge" to fix the affected upper limb and chest and abdomen in negative pressure group. Patients in plaster group were treated with conventional dry gauze matting and plaster fixation. On post surgery day (PSD) 1, 3, 5, 7, and 14, flap blood circulation and pain intensity of patients in the 2 groups were calculated by self-made blood flow scoring scale and Changhai Pain Ruler, respectively. On PSD 5, the common complications in operative area and surrounding skin were observed and their incidences were calculated. On PSD 7, satisfaction degree of patients was scored. During follow-up of one month after pedicle division, the appearance and functional recovery of the affected limb were observed. Data were statistically analyzed with analysis of variance for repeated measurement, independent samples t est, Cochran & Cox approximate t test, chi-square test, and Wilcoxon rank-sum test. Results: On PSD 1, 3, 5, 7, and 14, the flap blood circulation scores of patients in negative pressure group did not change significantly, while that of patients in plaster group showed a time-dependent decrease, and the flap blood circulation scores of patients in negative pressure group were significantly higher than those in plaster group (t=2.259, 2.552, 2.784, 2.821, 3.003, P<0.05 or P<0.01). There were no significant changes in the pain intensity scores of patients in negative pressure group, while those of patients in plaster group increased in a time-dependent manner, and the pain intensity scores of patients in negative pressure group were significantly lower than those in plaster group (t=-4.818, -4.944, -5.011, -5.976, -6.721, P<0.05). On PSD 5, the incidences of common complications in operative area and surrounding skin of patients in negative pressure group were significantly lower than those in plaster group (χ2=6.773, 5.269, P<0.05 or P<0.01). On PSD 7, the satisfaction score of patients in negative pressure group was 14.7±1.1, which was significantly higher than 7.4±1.8 in plaster group (t=23.934, P<0.01). During follow-up of one month after pedicle division, the appearance and function of the affected limb of patients in the 2 groups recovered well. Conclusions: After repairing the upper limb soft tissue defect wound with pedicled abdominal flap, the bridge-type continuous negative-pressure suction fixation can effectively immobilize the affected limbs, chest and abdomen, reduce the incidence of common complications in the operative area and surrounding skin, relieve the pain of immobilization of patients, improve the blood circulation of flap and patient's satisfaction. Thus, it is an effective, portable, comfortable, and easy-to-operate method.

Clinical Application of Artificial Dermis and Autologous Skin in Repairing Skin and Soft Tissue Defects of Hands and Feet with Bone Exposure Injuries.

Patients with skin and soft tissue defects are very common. Mild trauma often causes mild skin damage, while severe injuries are often accompanied by bone and tendon exposure, which brings great pain to patients. For the defect of skin and soft tissue, the traditional treatment methods are mostly medium or full-thickness skin or skin flap transplantation. These methods are effective in wound repair, but there are still many problems. In recent years, with the improvement of tissue engineering technology, the use of artificial skin to repair various skin wounds is gradually becoming clinical, and the key technology of skin tissue engineering lies in the development of dermal substitutes. The appearance of artificial dermis not only solves the shortage of autologous skin source but also makes the operation simple and easy. The purpose of this study was to investigate the clinical effect of artificial dermis combined with autologous skin grafts in repairing hand and foot skin and soft tissue defects with bone exposure. The results show that the use of artificial dermis combined with autogenous blade thick skin to treat patients with hand and foot soft tissue injury with bone exposure has a good clinical effect, and the skin is alive and has fewer complications, which is worthy of promotion.

Clinical effect of perforator flap combined with toe transplantation for repairing thumb damage with soft tissue defect of hand

Objective: To investigate the clinical effect of perforator flap combined with toe transplantation for repairing thumb damage with soft tissue defect of hand. Methods: The retrospective observational study method was used. From May 2014 to June 2019, 8 patients with thumb damage and soft tissue defect of hand were admitted to the 988th Hospital of Joint Logistic Support Force of PLA, including 6 males and 2 females, aged from 25 to 46 years. Among them, thumb damage in 3 cases were degree Ⅱ, 1 case was degree Ⅲ, and 4 cases were degree Ⅳ. All thumb damage were repaired with perforator flap combined with toe transplantation. The skin and soft tissue defects of hand were repaired by free anterolateral thigh perforator flap in 6 cases and free deep inferior epigastric perforator flap in 2 cases. The thumb damage of degree Ⅱ was repaired by the first toe transplantation combined with perforator flap, and thumb damage of degree Ⅲ or Ⅳ was repaired by the second toe transplantation combined with perforator flap. The survival and blood supply of reconstructed thumbs and flaps, and wound healing of donor sites were observed after surgery. All the patients were followed up for 10 to 18 months, the appearance of the reconstructed thumbs, sensory recovery, and foot walking function were observed. At the final follow-up, the functional reconstruction of the thumb was evaluated. Results: All the blood supply and survival of the reconstructed thumbs and flaps were good, and all the wounds of donor sites healed well. During the follow-up, the appearances of the reconstructed thumb and flap were good, the sensation of pain and touch of the finger pulp recovered well, and no significant impact on foot walking function was observed. At the final follow-up, the function of reconstructed thumb was evaluated as excellent in 4 cases, good in 3 cases, and fair in 1 case. Conclusions: The repair method of perforator flap combined with toe transplantation technique can complete the targeted repair of thumb damage with skin and soft tissue defect of hand in one stage, minimizing the foot donor site injury and shortening the course of disease and early rehabilitation, which is one of the ideal methods for the treatment of complex thumb damage.

Clinical Effect of Holistic Nursing in Treating Traumatic Soft Tissue Defect of Hand and Foot with VSD Technique

Clinical Effect of Holistic Nursing in Treating Traumatic Soft Tissue Defect of Hand and Foot with VSD Technique

Flap Repair Technique for Soft Tissue Defects of the Hand.

Repair for the soft tissue defects of hand has been a major challenge of hand or reconstructive surgery. A lot of flaps are used, free or pedicle flap, but there are no comprehensive description of these flaps. In this article, we retrospectively reviewed the repair technique of the fingertip defect, palmar or dorsal defect of the hand, by using different flaps in 14 cases, between June 2010 and December 2014, and the advantages and limitation of each flap are simply stated. We have shown a lot of surgical pictures, with a small amount of text, providing a wide range of ideas for the surgeon to freely choose an easy and effective method for his own technology. Overall, these approaches are simple, safe, and effective for repairing the soft tissue defect of the hand.

Study on Chitosan-Based Nanocomposite Hydrogel in Soft Tissue Defect of Hand

Hand soft tissue defects are a common disease in surgical emergency, which seriously affects the limb function of patients and significantly reduces their quality of life. To effectively repair hand soft tissue defects, a difficult problem posed to surgeons, we report here the use of a chitosan-based nanocomposite hydrogel (CS-GEL-PDRN). In vitro experiments showed that the nanocomposite hydrogel could promote the proliferation of human embryonic fibroblasts M-22 and human vascular endothelial cells EC-304. In addition, the hydrogel had excellent blood compatibility. In the rabbit model of soft tissue defects, CS-GEL-PDRN effectively coordinated cytokine responses, accelerated wound healing and promoted tissue repair. Based on this, CS-GEL-PDRN is expected to play a clinical role in the repair of hand and other soft tissue defects in the future.

Reverse Posterior Interosseous Artery Flap: A Reliable, Comfortable and Versatile Flap for Coverage of Soft Tissue Defects of Hand

Background: Soft tissue defects of the hands require coverage with soft, pliable full-thickness skin. The posterior interosseous artery (PIA) flap fulfils all these requirements and also has significant advantages over other flaps; it is a single-stage procedure that does not sacrifice major vascular axis of the hand. However, the dissection can be challenging and requires meticulous skill. The objective of the study was to evaluate the reverse PIA flap for coverage of hand soft tissue defects in terms of its safety, reliability, comfort, function and aesthetic appearance.Methods: Over a period of 3 years, patients with soft tissue defects over the dorsum of the hand and first web space were observed. A standard PIA flap was raised using loupe magnification under general or brachial anesthesia. The size and location of the defect were noted along with the size and success of the flap.Results: Twelve patients, including nine males and three females, were taken up for this procedure. All the flaps survived completely except one with marginal necrosis not requiring a secondary procedure. All patients were quite satisfied with the procedure and went on to resume their work within a month or two.Conclusion: PIA flap is a safe, reliable option with great versatility for coverage of hand defects, especially over the dorsum. A well-planned flap surgery done under loupe magnification affords excellent results. The entire treatment also requires a shorter hospital stay and allows the patient to return to work quickly.

Free sensate intercostal artery perforator flap for hand soft tissue reconstruction

To investigate the effectiveness of free sensate intercostal artery perforator flap for the hand soft tissue reconstruction. Between March 2010 and September 2015, 19 cases of hand soft tissue defect were repaired with free sensate intercostal artery perforator flap, including 16 males and 3 females, aged from 18 to 53 years, with an average of 35.2 years. The defect was located in the dorsum of the hand in 15 cases and in the palm in 4 cases. The causes of injury were traffic accident injury in 8 cases, hot crush injury in 5 cases, strangulation injury in 4 cases, and avulsion injury in 2 cases. All of them were full-thickness skin and soft tissue defects of hand with exposure of phalanges, tendons, blood vessels, and nerves. The size of defect was 10.0 cm×7.0 cm to 17.0 cm×8.0 cm. There were 12 cases of emergency operation and 7 cases of selective operation. The thickness of flap was 10-25 mm, and the size of the flap ranged from 10.0 cm×7.5 cm to 17.0 cm×8.0 cm. The vascular pedicle of the flap was anastomosed with the snuff nest branch of the radial artery (12 cases), the main radial artery (7 cases), and there accompanying vein, and the intercostal nerve cutaneous branch of the flap was anastomosed with the lateral cutaneous nerve of the forearm. The donor site was closed directly (14 cases) or repaired with medium thickness skin graft (5 cases). All of the flaps and skin grafts survived; the wounds in the donor and recipient sites healed by first intention. All 19 patients were followed up 10- 18 months, with an average of 12.7 months. After operation, the appearance and function of the hand recovered well, and there was no flap bloated. The two-point discrimination of the flap was 7-11 mm, with an average of 8.8 mm. Only linear scars left in the patients with direct closure of the donor site. The sensory function of the donor site was not significantly affected, and the hand function recovered satisfactorily. Free sensate intercostal artery perforator flap is a valuable and reliable technique for the hand soft tissue defect.

Clinical application of proximal periosteal perforator bone-skin flap of anterior tibial artery for repair of the composite tissue defects of the hand and foot

Objective To investigate the clinical efficacy of proximal periosteal perforator bone-skin flap of anterior tibial artery for repair of the composite tissue defects of the hand and foot. Methods March 2015 to October 2017, 24 cases of the composite tissue defects of the hand and foot were repaired by free transplantation of the proximal periosteal perforator bone-skin flap of anterior tibial artery, including 12 cases of hand and 12 cases of foot. There were 6 cases of tendon injury and 1 case of joint defect. The skin defect area ranged from 3.0 cm × 0.8 cm to 10.0 cm × 5.5 cm. The size of bone defects ranged from 1.7 cm×1.5 cm ×1.0 cm to 5.0 cm×1.0 cm×1.0 cm. The anterior tibial margin of the talus-tibial tubercle (3.2 ±0.8) cm was the penetrating point, and the bone-skin flaps were designed with this as the center. After operation, hand function was followed up according to Michigan Hand Function Evaluation Standard, and foot function was evaluated according to Maryland Foot Score Standard. Results All the flaps survived, of which 21 cases were follow-up for 6 to 24 months, with an average of 12.3 months, and 3 cases were lost. The skin flaps were soft, elastic, moderately thick and nearly normal skin. At the last follow-up, the sensation of the flaps restored to S2 to S3. The two-point discrimination was 6 to 11 mm, with an average of 8.9 mm. Two-stage thinning operation of fingertip flaps was performed in 3 cases. Finger shape and function recovered well. The healing time of the transplanted bone and skin flaps ranged from 2 to 4 months, with an average of 2.3 months. No delayed or nonunion occurred. There was no influence on leg and foot weight-bearing walking. Michigan hand function score was excellent and good in 8 cases and Maryland foot score was excellent and good in 12 cases. Conclusion The proximal periosteal perforator of anterior tibial artery has a constant position. Its bone and skin flaps are suitable for repairing small and medium-sized composite tissue defects in hand and foot. Key words: Surgical flaps; Treatment outcome; Anterior tibial artery; Periosteal perforator; Composite tissue defects

Effects of medial upper arm bilobed free flaps in the repair of two skin and soft tissue defects of hand

Objective: To summarize the effects of medial upper arm bilobed free flaps in the repair of two skin and soft tissue defects of hand. Methods: From May 2014 to May 2016, 7 patients of two skin and soft tissue defects of hand with exposures of phalanges and tendons were treated in Xuzhou Renci Hospital, including 5 males and 2 females, aged from 19 to 41 years. Each defect area ranged from 3.0 cm×1.5 cm to 6.0 cm×3.0 cm. The medial upper arm bilobed free flaps were used to repair the defects, and the area of each lobe of the flaps ranged from 4.0 cm×2.0 cm to 8.0 cm×3.5 cm. The donor sites were sutured directly. The survival of the flaps was recorded. During follow-up, the recovery of donor and recipient sites was observed, the two-point discrimination distance of the flaps was measured, and the hand function was assessed by the trial criteria of the upper limb functional assessment of the Hand Surgery Society of the Chinese Medical Association. Results: All flaps survived smoothly, and the wounds and donor site incisions were healed. All patients were followed up, and the follow-up time lasted for 6 to 15 months. The color and texture of the flaps were similar to the surrounding normal skin, and the shape of the flaps was good. There was no obvious scar in the donor site, and the elbow joint function was normal. One patient developed ulnar numbness one month after operation and relieved after 3 months of treatment with neurotrophic drugs and local physiotherapy, etc. Six months after operation, the two-point discrimination distance of the flaps was 5.5-8.0 mm, and the hand function evaluation was excellent in 3 cases, good in 3 cases, and middle in 1 case. Conclusions: The medial upper arm bilobed free flap has both good texture and good appearance, and the scar of donor site is concealed. It is a good method to repair two skin and soft tissue defects of hand.

Repair of resurfacing soft tissue defect of hand with radial collateral artery polyfoliate perforator flap

To explore the feasibility and effectiveness of radial collateral artery polyfoliate perforator flap in repair of resurfacing soft tissue defect of hand. Between September 2017 and September 2018, the radial collateral artery polyfoliate perforator flaps were transplanted to repair 5 cases of two adjacent wounds of hand and wide or irregular wounds. All patients were male, aged from 27 to 52 years, with an average of 42.5 years. The time from injury to admission was 4 hours to 3 weeks, with an average of 7.3 days. Causes of injury included traffic accident in 2 cases, crushing injury in 2 cases, and paint injection injury in 1 case. The wounds were located at the dorsum of hand in 3 cases, the dorsum of finger in 1 case, and the thumb and thumb web in 1 case. The area of wound ranged from 8 cm×6 cm to 10 cm×8 cm. The area of skin flap ranged from 6.0 cm×3.0 cm to 11.0 cm×4.5 cm, all of which carried the posterior cutaneous nerve of the arm, and the donor site was closed directly. All flaps survived and healed by first intention. All patients were followed up 3-11 months (mean, 6.5 months). The patients were satisfied with the appearance of hands. The flaps were not bulky, and the color and texture were similar to the hand. There was only linear scar in the donor site, no radial nerve injury occurred, and elbow joint function was not affected. One patient underwent finger-splitting and skin flap thinning at 6 months after operation. The radial collateral artery polyfoliate perforator flap is a good method for repairing two adjacent wounds and wide or irregular wounds of hand.