[Clinical application of irregular anterior lateral femoral flap in hand surgery].

OBJECTIVE: To introduce a method to repair soft tissue defect in different regions and different areas of hand in one procedure.

METHODS: From May 2002 to May 2005, anterolateral femoral flap or lobulated anterolateral femoral flap (forming irregular anterolateral femoral flap) was designed into different shapes to repair multiple soft tissue defect in different regions in hand, which was used clinically in 27 cases. Among 27 cases, there were 16 males and 11 females; the locations were left hand in 9, right hand in 16 and left foot in 2; including 5 penetrating injury, 9 hot pressing injury, 2 soft tissue defection of instep and plantae by milled injury, 6 gearing injury and 5 carding machine injury. All the cases complicated by exposure of tendons, bones or joints. Defect was repaired with H-shape flaps in 5 cases of penetrating palm injuries; with Y-shape or K-shape flaps in 11 cases of dorsal or combined with fingers of hand with skin defect; with perpendicular-shape flaps in 3 cases of dorsal combined with sides of palms or the first web of hands with skin defect and in 2 cases of skin defects of dorsal combined with palms of feet; with h-shape flaps in 6 cases of skin defects of dorsal or palms combined with disconnected skin defect of fingers. The sizes of main flaps ranged from 6.5 cm x 4.8 cm to 17.0 cm x 12.0 cm, the sizes of lobulated flaps ranged from 3.5 cm x 2.8 cm to 7.5 cm x 4.5 cm.

RESULTS: All flaps survived without vascular crisis after operation. Except the fascia flap all recipient sites healed by first intention. The follow-up period ranged from 3 months to 1 year, all cases had satisfactory appearance, the texture of flaps was soft. Except 2 cases of penetrating injury, 3 cases of hot pressing injury and 1 case of carding machine injury whose function was not satisfactory, the remaining cases achieved the function of snap and pinch. More than 1 year after operation, the sense of pain and touch recovered. There was no functional impairment at the donor sites although scar hyperplasia was formed in some cases.

CONCLUSION: The application of irregular anterolateral femoral flap is an optimal choice for complex skin defect of hand.