Fit The Cephalic Vein And Superficial Branch Of Radial Nerve Nutrition Blood Vessels Fascia Flap Application Research

Objective:To compare the clinical effects of the flap with or without anastomosis of cephalic vein and superficial branch of radial nerve in repairing soft tissue defects in hand.Objective:To explore the application of the flap with anastomosis of cephalic vein and superficial branch of radial nerve in repairing soft tissue defects in hand.Methods:The flap with anastomosis of cephalic vein and superficial branch of radial nerve was used for the repair of hand skin soft tissue defect at the microscope.32patients in treatment group were applied with anastomosis of cephalic vein and superficial branch of radial nerve, including22males and10females,aged18～46. The causes of injuries were cutting injury (8patients), machines related injury (18patients), burning injury (2patients). The types of injuries were the skin defect of dorsal-ulnar thumb (12patients), the skin defect of dorsal-radialis thumb (14patients), the skin defect of the middle and far section of the index finger and the middle finger (14patients). There were20cases with tend on injuries and8cases with fracture,15cases with selective operation,17cases with emergency operation. And34cases in control group were without anastomosis of cephalic vein and superficial branch of radial nerve. including24males and10females, aged25～54. The causes of injuries were cutting injury (7patients), machines related injury (19patients), traffic related injury (5patients), burning injury (3patients). The types of injuries were the skin defect of dorsal-ulnar thumb (15patients), the skin defect of dorsal-radialis thumb (14patients), the skin defect of the middle and far section of the index finger and the middle finger (5patients). There were14cases with tendon injuries and10cases with fracture,15cases with selective operation,19cases with emergency operation. Results:The degree of flap swelling was shown by computation of the circumference of the recipient area before surgery, immediately after surgery and at3days after surgery.8swelling occurred in treatment group (25%), and18swelling occurred in control group (53%), the difference was statistically significant (p=0.0202), the flap swelling is greatly decreased than that of the control group.Venous congestion was seen in7patients in treatment group (21.9%), and17patients in control group (50%), the difference was statistically significant (p=0.0176), the f venous congestion is greatly decreased than that of the control group.Blister occurred in6patients in treatment group (18.8%), and15patients in control group (50%), the difference was statistically significant (p=0.0270), the occurrence of blister is greatly decreased than that of the control group.Anti-inflammatory, anti-coagulant and anti-paralysis therapy was used in treatment group, there were2cases of bruising of flap margin (6.25%), the blood supply turned better after suture dismantled. In the control group, there were14cases of bruising of flap margin,12cases of necrosis of flap margin, the wound was then treated with debridement and skin graft, the difference of flap margin necrosis was statistically significant between the two groups (p=0.0002), the occurrence of flap margin necrosis is greatly decreased than that of the control group.The average days of hospitalization of the treatment group was19.2±4.9days (14～38),that of the control group was25.1±5.6days(16～45),the difference was statistically significant between the two groups (p=0.000), The average days of hospitalization is greatly decreased than that of the control group.All patients were followed up for averaged12months, the sensory recovery rate was100%in the treatment group,67.7%in the control group, which was statistically significant between the two groups (p=0.0004)All patients were followed up for averaged one year, the patients were adopted with routine appointment out-patient clinic. According to the TAM hand functional assessment,16cases got excellent result,12case good,4case poor in the treatment group.11cases got excellent result,8case good,9case poor in the control group, the difference was statistically significant between the two groups (p-0.014), the sensory was significantly better in the treatment group.Conclusion:1. The flap with anastomosis of cephalic vein and superficial branch of radial nerve has fewer complications, alleviated flap edema and reduced venous stasis.2. The flap with anastomosis of cephalic vein and superficial branch of radial nerve has high survival rate, and no flap edge necrosis.3. The flap with anastomosis of cephalic vein and superficial branch of radial nerve has advantages of massive donor area and repaired area.4. The flap with anastomosis of cephalic vein and superficial branch of radial nerve has fine feelings, and it is ideal in repairing soft tissue defects in hand.