Repair of children's hand defect by using forearm medial cutaneous nerve nutrient vascular flap with tendon
Objective To investigate the effect of repairing children's hand defects with the combined tendon of forearm medial cutaneous nerve nutrient vascular flap.Methods From October 2019 to December 2021,19 children with hand skin and soft tissue defects were admitted.There were 11 males and 8 females.The age ranged from 9 to 16,with an average age of 14.The time from injury to operation was 2-8 h(mean 3.5 h)in 16 cases.Two cases were of ungloved injury;one case was after the resection of contracture of tiger mouth.Defects:4 cases on the ulnar side of the hand,7 cases on the radial side of the palm,5 cases on the ulnar side of the palm,2 cases on the radial palmar side of the thumb,and 1 case on the tiger mouth.All the 19 cases were accompanied by bone and tendon exposure or defects.The wound range was 3 cm×3 cm-12 cm×8 cm.Nutritional vascular flaps of medial forearm cutaneous nerve with a combined tendon size of 3.0 cm×3.6 cm-13.2 cm×9.1 cm were used for repair,and the medial forearm cutaneous nerve was anastomosed with the receiving area cutaneous nerve in 11 cases.Donor area direct suture or skin graft repair was applied.Results The distal part of the skin flap was necrotic and healed 4 weeks after dressing change.All the other 17 patients survived.The donor incision and wound healed in stage Ⅰ and the skin survived.All the 19 cases were followed up for 5-30 months,with an average of 12 months.The skin flap has good texture and satisfactory appearance.At the last follow-up,the sensory recovery of the flap was S2-S3+.The sensation of 11 cases with anastomotic cutaneous nerve flaps was S3-S3+,which was better than S2-S3 of 8 cases without anastomotic cutaneous nerve flaps.The tendon function of the hand recovered satisfactorily in 19 patients who underwent composite part bridge transplantation of flexor carpi ulnar tendon.Only 3 patient had total active motion>80%of the healthy side at the last follow-up.At the last follow-up,16 cases were excellent and 3 cases were good according to the functional evaluation criteria of the Hand Surgery Society of the Chinese Medical Association.Conclusions The forearm medial cutaneous nerve nutrient vascular flap with combined tendon can not only repair the defect of the hand,but also rebuild the function of the affected limb.
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