OBJECTIVE: To discuss the method to repair the defects of palm with the improved flaps pedicled with the dorsal carpal branch of ulnar artery. METHODS: The improved flaps were designed on the basis of anatomical distribution of the dorsal carpal branch of ulnar artery and the medial antebrechial cutaneous nerve, the ulnar artery was ligated and cut at the beginning of its dorsal carpal branch. The flap pedicled with dorsal carpal branch including the distal ulnar artery was achieved and applied clinically to repair 15 cases of the skin and soft tissue defects of palm from August 1997 to November 2001. The size of flaps ranged from 7 cm x 5 cm to 12 cm x 8 cm. RESULTS: All of the cases were followed up 3 weeks to 6 months, and the flaps completely survived. There was no ischemia and necrosis at the distal part of flaps and the appearance and function was satisfactory. CONCLUSION: The improved flap has long vascular pedicle, abundant blood supply and sensitive sensation, so it can be used to repair defect of palm.
ObjectiveTo investigate the effectiveness of medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery in the repair of palm soft tissue defect. MethodsBetween September 2013 and December 2015, 9 cases of palm soft tissue defects were repaired with medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery. There were 7 males and 2 females with a mean age of 33 years (range, 21-52 years). The causes included traffic accident injury in 4 cases, crushing injury by heavy object in 3 cases, and electrical injury in 2 cases. The time between injury and admission was 3 hours to 2 days (mean, 9 hours). Five cases had pure soft tissue; combined injuries included tendon exposure in 2 cases, median nerve defect in 1 case, and exposure of tendon and nerve in 1 case. After debridement, the soft tissue defect area ranged from 6 cm×4 cm to 11 cm×6 cm. The flap size ranged from 7.0 cm×4.5 cm to 13.0 cm×7.0 cm. The vascular pedicle length was from 6 to 10 cm (mean, 7.5 cm). The donor sites were covered with ilioinguinal full thickness skin graft. ResultsNine flaps survived, primary healing of wound was obtained. Partial necrosis occurred at the donor site in 1 case, and the other skin graft successfully survived. All patients were followed up 6-20 months (mean, 10 months). All flaps had soft texture and satisfactory appearance; the cutaneous sensory recovery time was 4-7 months after operation (mean, 5 months). At last follow-up, sensation recovered to grade S4 in 4 cases, to grade S3+ in 3 cases, and to grade S3 in 2 cases; two-point discrimination was 7-10 mm (mean, 8.5 mm). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the hand function was excellent in 5 cases, good in 3 cases, and fair in 1 case. The donor foot had normal function. ConclusionThe medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery can repair soft tissue defect of the palm, and it has many advantages of soft texture, satisfactory function, and small injury at donor site.