Clinical Application Study Of Various Subdermal Vascular Network Flaps For Repairing Hand Soft Tissue Defects

Objective:To investigate the clinical application effects of split-finger abdominal subdermal vascular network flap,m-type abdominal subdermal vascular network flap and s-type abdominal subdermal vascular network flap in repairing wound surfaces of hand.Methods:A total of 66 patients with soft tissue defect of hand treated with split-finger,m type and s type abdominal subdermal vascular network flap in our hospital from March 2016 to June 2019 were selected as the experimental group,among them,27 cases(81 fingers)were repaired with split-finger abdominal subdermal vascular network flap,18 cases were repaired with m-shaped abdominal subdermal vascular network flap,and 21 cases were repaired with s-shaped abdominal subdermal vascular network flap,a total of159 skin flaps.Another 38 patients who used traditional full-thickness abdominal flaps to repair similar wounds at the same period were selected,and a total of 47 flaps were used as the control group.After the operation,the patients were instructed to carry out functional exercise in the early stage,pay close attention to the blood supply of the flap,observe the shape,color,temperature,texture,sensation recovery,hand function recovery and whether the flap thinning and flap fingering were needed after pedle amputation.The hand function was comprehensively evaluated according to the trial standard of hand function evaluation of Hand Surgery Society of Chinese Medical Association,and the sensory function recovery of the skin flap referred to the grading evaluation standard of sensory function recovery proposed by British Medical Research Council(BMRC),the above observation indexes of the experimental group and the control group were compared,the sensory function recovery score and hand function score of the skin flap of the experimental group 12 months after surgery were statistically analyzed with the control group respectively,and the above indexes were comprehensively analyzed to determine the clinical efficacy of the three kinds of subdermal vascular network skin flaps in repairing different wounds of the hand.Results: The mean follow-up time was 14.5 months(12 to 18 months).All 159 subdermal vascular network flaps in the experimental group survived,and 15 flaps showed symptoms of tension blisters and purple at the distal end,after removal of sutures and treatment with drugs,the flaps survived,most of the pedicle flap was broken for 10～14 days,after pedicle flap was broken,the flap had good shape,suitable thickness and soft texture,and no further flap thinning and flap finger splitting was needed.In the control group,all 47 skin flaps survived,and 6 skin flaps showed local necrosis,and survived after repeated debridement,most of the flaps had bloated appearance,and flap thinning and finger parting were needed,and most of the pedicle amputation time was 21～28 days.The excellent and good rate of hand function was 85%in the patients treated with split-finger subdermal vascular network flap 12 months after operation;the excellent and good rate of m-type skin flap was83%;the excellent and good rate of s-type flaps was 86%;the excellent and good rate of 38 patients with traditional full-thickness free abdominal flap was74%.The sensory function recovery score and hand function score of the experimental group were compared with that of the control group,respectively,there was no statistically significant difference in sensory function recovery(P=0.680,P=0.747,P=0.962),the difference in hand function score was statistically significant(P=0.004,P=0.018,P=0.010).Conclusions: Through the comprehensive analysis of various indicators,we believe that it is a very good choice to use split-finger subdermal vascular network flap to repair the skin defect of the fingertips or dorsal fingers;m-type subdermal vascular network flap has good effect on the skin defect of dorsal hand and dorsal finger;the s-type abdominal subdermal vascular network flap can be used to repair the dorsal palmar sleeve skin defect of the hand or finger sleeve skin defect in one time.These three types of abdominal subdermal vascular network skin flaps have a wide range of application,simple operation,and can be used for functional practice in early pedicle cutting.Their clinical efficacy is superior to that of the traditional full-thickness abdominal free skin flaps,and they are worthy of clinical promotion and application.