Skin Defect Of The Finger With The Free Flap Which With Tendon Pedicled On The Supracarpal Palmar Perforator Of Ulnar Artery

Background:Since the1980s, perforator flap get larger development. In1988s, Becker reported the clinical application of Dorso-ulnar flap based on supracarpal perforator. In1989s, on the basis of anatomical study, Zhanggaomeng et al applied this perforator flap to repair the hand skin soft tissues defect. The pattern repairing hand soft tissues defect evolved from pedicle flap to free flap transplantation, and obtained the good effect. In2011s, Zhangwenfeng et al reported the cases using free Dorso-ulnar flap based on supracarpal perforator which with tendon to repair skin and tendon defect of the finger. At present, the main methods to repair hand skin and tendon defect were dorsal digital island flap, dorsal carpometacarpal island flap, cross-finger flap, and apply PL tendon for repairing tendon defect. Donor site was repaired with full-thickness skin graft harvested from upper arm and abdomen.Clearly, It is just needed only one operation site to use Dorso-ulnar flap based on supracarpal perforator which with partial flexor carpi ulnaris tendon to repair skin and tendon defect of the finger. Greatly reduced the damage and destruction of the donor site.Objectives:25patients (26fingers)with dorsal skin defect of fingers were repaired with the free flap with suracarpal palmar perforator branch of ulnar artery and partial flexor carpi ulnaris tendon. The patients were followed for6to24months, Summarized the flap survival situation, appearance, sensory recovery, tendon healing, ringer function, etc. Further summarized the clinical experience of this method to repair finger dorsal skin and tendon defect and to offer the clinical sustain for popularizing application. It was a good technique to solve the tendon and skin soft tissue defect of hand.Methods:From January2008to December2013, there were25cases (26fingers) which with dorsal skin and tendon defect repaired with free Dorso-ulnar flap based on supracarpal perforator which with partial flexor carpi ulnaris tendon(half thickness of the tendon, is about2.5-6.0cm), aponeurosis was retained within the flap to keep the blood supply of the tendon.Clinical micro-dissection was done,and further summarized the features of perforators. To observe the survival law, arteriovenous crisis and principles of treatment for one week.Patients were followed up on the3rd week, the1.5st,3rd,6th,12th and24th month postoperatively. To observe the donor and recipient site appearance and finger function, Further summarized the clinical application characteristics and experiences. Results:In clinic,25cases(24fingers) were successfully survived, The patients were followed for6to24months. The flaps were not bulky, the sensation is S3-S3+. Arterial crisis happened in1case, which is survived after another surgery. Bubbles and violet happened in3cases, after partial suture removal,1case is survived, and1case of partial necrosis,1case of complete necrosis. Flap color was similar to the district, no obvious bloated. Donor site scar contracture was not obvious. The motion and power of wrists were normal.Conclusions:There are several permanent perforators on the dorsal forearm area, branch numbers are1-3piece, and meet the design requirements. The skin texture of the site is close to the dorsal finger. It is feasible to implement single body anesthesia, and is accepted easily by patients. The donor site can suture directly, the look is good, the feeling and functions are satisfactory. Therefore, for small and medium-sized skin and tendon defect of the dorsal finger, free Dorso-ulnar flap based on supracarpal perforator is a good choice, it is worthy to be clinical extended and application.