| Objective: The purpose of this study was to identify relative benefits between lateral upper arm free flap and anterolateral thigh free flap in repairing tissue defects of opisthenar,by comparing the indexes of the efficacy after the surgery using the two different flaps.Furthermore,this research can provide the basis for the precise option of flap and indications before repairing the tissue defects of opisthenar by microsurgery.Methods: Between September 2013 and March 2016,44 male patients and 13 female patients with tissue defects in opisthenar were treated with lateral upper arm free flap or anterolateral thigh free flap in Department of Hand Surgery.The number of lateral upper arm free flap and anterolateral thigh free flap were 26 and 31 respectively,and cases also addressed the restoration of sensation were 14 and 17 respectively.The deadline of following up was January 2017,and the follow-up time of the two groups was in the range of 7 to 24 months(average,13.6 for LUAF,14.3 for ALTF).Patients' clinic materials include general information,size of flap,operative rate of success,rate of plastic surgery of flap,total rate of morbidity of donor and receipt site,excellent rate of sensation recovery,hand function according to assessment criteria of upper limb by Hand Surgery Branch of Chinese Medical Association.Postoperative significant complications in the study include vascular crisis,hematoma,infection,wound dehiscence,partial necrosis,delayed healing in receipt site and short-term disability of elbow and knee joint,numbness,paresthesia,hyperplastic scar,skin hyperpigmentation in donor site.Patients assessed degree of satisfaction with postoperative complications and aesthetic appearance using self-report questionnaire.Results: There are no significant differences between lateral upper arm free flap and anterolateral thigh free flap in general information(p>0.05),hand function,the operative rate of success(92.31%,93.55%),total rate of mobidity in receipt(23.08.%,32.26%),total rate of mobidity in donor site(65.38.%,54.83%),score of satisfaction in donor site(4.35,4.03).The excellent rate of sensation recovery was 64.71%,78.57% respectively.No vital difference in morbidity of donor and receipt site were detected such as vascular crisis(7.69%,6.45%),hematoma(11.53%,16.13%),infection(3.85%,6.45%),wound dehiscence(7.69%,12.90%),partial necrosis(15.38%,25.58%),paresthesia(15.38%,6.45%)numbness(38.46%,22.58%),hyperpigmentation(19.23%,23.26%),hyperplastic scar(7.69%,16.13%),disability of elbow and knee joint(34.61%,22.58%)between lateral upper arm free flap group and anterolateral thigh free flap group(p>0.05).However,there are some outcomes with statistic difference in as follows(p<0.05).The mean size of lateral upper arm flap group was 80±18cm2,and anterolateral thigh flap group was 143±44cm2.The rate of flap in delayed healing in receipt site present in 7.69%,29.00%respectively.The rate of plastic surgery of flap(30.77%,48.39%).Patients satisfaction with the receipt site was rated 3.77 for lateral upper arm flap group and 3.19 for anterolateral thigh flap group(1=poor,6=excellent).Conclusions: Lateral upper arm free flap and anterolateral thigh free flap in repairing tissue defects of opisthenar can both receive an ideal operative rate of success and less morbidity in donor and receipt site.The total rate of mobidity both in receipt and donor site has no significant difference.The mean size of anterolateral thigh free flap group was larger than lateral upper arm free flap group.In terms of sensory repairing,there are no significant differences in excellent rate of sensory recovery betweentwo groups.The outcomes of significant complication and satisfaction of donor site between two groups were similar.However,lateral upper arm free flap can result in better aesthetic outcomes and higher score of satisfaction in receipt site. |
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