Selection And Clinical Application Of Free Lower Abdominal Perforator Flap Under Localization Of Color Doppler Ultrasound

Objectives To investigate the clinical effect and application of free lower abdominal perforator flap for repair of hand skin soft tissue defect under localization of color Doppler ultrasound.Methods We collected 28 cases with hand skin soft tissue defect,which were repaired with free lower abdominal perforator flap with superficial iliac artery and iliac artery from October 2010 to February 2017.Of these patients,23 males and 5 females,age range from 17 years old to 50 years old,with an average age of 32.9 years old.All patients were accompanied with deep tissue tendons and bone exposure.The area size of defect wound range from a minimum about 6cm × 4cm to the maximum about 15 cm × 11 cm.Using the color Doppler ultrasound to determine the shape of perforator flap before surgery,and take this as the axis,according to the shape and size of the defect,lower abdominal flap with a shallow iliac artery or a superficial abdominal artery was designed,in which the superficial abdominal artery pedicle flap in 20 cases,screw pedicle in 8 cases,the abdomen of 27 cases with direct suture,1 case of partial suture and some skin graft.Results All the flaps of 28 cases with I stage survived after operation,and no vascular crisis occurred.Only one case with postoperative infection,the flaps were mainly marginal red with exudate,and local skin temperature was high.After the bacteria culture,the patients were healed well after using antibiotics and multiple dressing changes.All patients were effectively followed up for 5 months to 24 months with an average time of 11 months.Skin flaps were soft and with good elasticity.12 postoperative patients due to flaccid flap,skin flap plastic surgery,postoperative bloated significantly reduced.The appearance of flaps were satisfied,no pigmentation.Flap recovery feeling of protective,perspiration,pain and warm.Hand activities after surgery were satisfied.Lower abdomen left linear scar,there are 2 cases with scar mild hyperplasia,no obvious contracture.Function of hip joint is normal,and no sensory abnormalities.Conclusion The repair of hand skin soft tissue defect under localization of color Doppler ultrasound with advantages of accurate and intuitive judgment of the situation of perforation,which also overcome the defect that the flap cannot be cut because of vascular variation.According to perforation,it is flexible to design the free flap with blood supply from iliac artery or shallow superficial artery,which is an ideal method for repairing soft tissue defects in the hand.