Free chimeric mini-flap pedicled with superficial palmar branch of radial artery with flexor carpi radialis tendon in reconstruction of composite tissue defect of dorsal fingers
Objective To explore the surgical procedure and clinical efficacy of free chimeric tendon mini-flap pedicled with superficial palmar branch with flexor carpi radialis of radial artery in reconstruction of the dorsal finger composite tissue defects.Methods From January 2020 to December 2022,6 fingers(6 patients)with com-bined dorsal soft tissue and extensor tendon defects were treated in the Department of Plastic and Reconstructive Surgery,the First Affiliated Hospital of Ningbo University.The ipsilateral free chimeric flexor carpi radialis tendon mini-flap pedicled with superficial palmar branch of radial artery was used to reconstruct the soft tissue defects that sized 1.5 cm×1.8 cm-2.5 cm×3.0 cm and the extensor tendon defects ranged 1.5-2.5 cm in length.The flap donor sites were directly sutured.Blood supply and survival of the flaps were observed after surgery.Postoperative follow-ups were scheduled at the 1,3,6,12,18 and 24 months after surgery and mainly conducted at the outpatient clinic and by home visits.Patients who were inconvenient to visit the hospital were reviewed through WeChat or telephone interviews.The follow-up included the colour,texture,appearance,sensation of the flap and functional status of the affected fingers.Results After surgery,all 6 flaps survived without any incidence.All flap donor sites achieved stage Ⅰ healing.The postoperative follow-up lasted 6-22(mean 11.3)months.The colour and texture of the flaps were similar to those of the skin of dorsal finger,without bulky appearance.For the 3 flaps that had nerve anastomoses,the sensation recovery of the flap achieved to S3+,with TPD at 7.6 mm,7.9 mm and 8.3 mm,respec-tively,and 7.93 mm in average.For the 3 flaps without nerve anastomosis,the sensation recovery of the flap achieved S3.No complication occurred at the donor sites.According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association,4 patients were in excellent and 2 in good.Conclusion Transfer of free chimeric flexor carpi radialis tendon mini-flap pedicled with superficial palmar branch of radial artery in reconstruction of the soft tissue defect in dorsal finger offers the advantages of reliable blood supply,sufficient blood reflux,bridging blood vessels,nerves and tendons,a minimal damage to the donor site and satisfactory postoperative outcome.It is an ideal surgical procedure for reconstruction of the composite tissue defects in dorsal finger.
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