Three Different Flaps For Coverage Of Soft Tissue Defects In The Hand: A Clinical Evaluation

【Background】 Flap repairing is the main method for coverage of soft tissue defects in the hand whose bone and tendon exposed. The process of drawing materials is complex, the donor sites must adapt to the need of the receient sites,whose operations demand higher technically requirements. Meeting with complex injury, we should try our best to reduce the times of surgical operation and alleviate patients’ pain, in consideration of further processing of repairing for bone and joint, nerve and tendon. Abdominnal flap is the simple, safe traditional skin flap for coverage of avulsion injury of skin and lage area skin defect of forethigh,, which is clinical flap in common use now,conform to the principle of tissue transplantation-----“By the district reconstruction, damage loss less donor site”,it can be accepted by patiens too.But it need two-phase operation broken predicle,and it’s so bulky of the transplantation of skin flap. The soft tissue defect of fingers can be repaired by the palm dorsal neurocutaneous vascular flaps(facial flap) nearby------ good appearance, normal texture and elasticity,superficial sensibility to some extent. The facial fap has reliable blood supply, without sacrificing the main blood supply, and easy resection,compled once time. But its shortcoming is the sensory deprivation to some extent at the dorsal donor sites. Free flaps are in completely separated state, which can survive by restoration of blood supply and sensation,though the method of blood vessel and nerves in new position after transplantation. The flaps have good appearance and satisfied sensormotor function on the receient sites. But it need high damand to operaters on technology, well teamwork and skillful microsurgery vascular anastomoses. According to statistics, it has failure rate:10%-30%.【Objective】 To evaluate the clinical results of facial flap,adominal flap and free flap for coverage of soft tissue defects in the hand and to provide useful guidance on clinical selection of flaps.【Methods】 Twenty-eight cases with soft tissue defects were divided into three teams,recruited in the Rui Hua Hospital of Soochow University from April 2010 to April 2014 : Fasial flaps 10 cases( male 9 cases, female 1 case, average age----33.2years old, from 4---48), they were all defects in finger belly;Adominal flaps : 8 cases( male 5 cases, femail 3 cases,average age 39.4 years old,from 24----63), 1 was upper extremity skin avulsion injury of soft tissue, 1 was soft tissue defect of four fingers,repaired by adominal watte flaps,others were in palms( back); Fre flaps: 10 cases( male 9 cases, female 1 cases, average age 32.3 years old, from 21----37),8 cases were soft tissue defects in finger, 2 cases in palms( back), 8 were lateral toe flaps, 1 was free dorsails pedis flap,1 was free anterolateral thigh flap. The injuries of hand were mainly located in finger belly and palms( back), some were located in forearm dorsal metacacarpal. All the cases were emergency operations. Follow up time : 17—52 months, average 34.5 months. The flaps were all survived, keeping regularly contract with the patients.With their general,clinical materials collected,DASH scores,touch and pressure( Semmes-Weinstein monofilament test), 2-point discrimination( motion 2PD and static 2-PD), thermal sensation, flap bulkiness and donor site contracture were recorded and analyzed statistically. The data was analyzed by SPSS 19.0. To retrospect and analyze the information about the clinical materials and operational photos of 28 patients.【Results】(1) There were no significant difference in all cleted data among these three different flaps(P>0.05), excpt for DASH scores, pressure and flap buikiness( P<0.05);(2) The DASH scores of adominal flap was much higher than the other two flaps(P<0.05);(3) The adominal flap was bulkier than the other two flaps( P<0.05);(4) The scores of pressure of adominal flap was much lower than the other two flaps(P<0.05);(5) The scores of free flap of 2-point discrimination,touch and thermal sensation were highest, but not significant(P>0.05).The free flap was bulkier than fascial flap, but not singnificant(P>0.05);(6) With their general, clinical materials, there were no significant difference in age and gender.(P>0.05).【Conclusions】(1) The adominal flap has obvious influence on the whole function and pressure of patients. It’s not good for the patients having high damand of appearance and fine motor function.(2) The adominal flap is bulky obviously. It’s apply to avulsion injury of largy area defects of forethigh.(3) The free flap has the best sensation, whose bulkiness degree is middle. It’s apply to the patients having high demand of fine motor function.(4) The fascial flap has the best appearance, whose sensation is middle,it’s apply to the patients having general damand of fine motor function.