[Improved pedicled superficial iliac circumflex artery flap for reconstruction of hand and forearm wounds]

Xiujun Tang, Zairong Wei, Bo Wang, Xueqin Zeng, Jing Tan
Chinese Journal of Reparative and Reconstructive Surgery 2012, 26 (8): 943-5

OBJECTIVE: To explore the effectiveness of the improved pedicled superficial iliac circumflex artery flap for repairing serious wound of the hand and forearm.

METHODS: Between June 2008 and June 2011, 13 cases of serious wound of the hand and forearm were treated. There were 9 males and 4 females with a mean age of 41 years (range, 23-64 years). The disease causes included twist injury by machine in 2 cases, wire rope squeezed injury in 4 cases, traffic accident injury in 3 cases, crushing injury in 2 cases, high voltage electrical injury in 1 case, and snake bites in 1 case. There were 10 cases of fresh wounds and 3 cases of infection and necrosis wounds, and all had bone and tendon exposure. The skin and soft tissue defects ranged from 7 cm x 3 cm to 22 cm x 6 cm. The pedicled iliac artery flap was used in 8 cases, and pedicled iliac artery composite flap in 5 cases. The flap size ranged from 12 cm x 4 cm to 27 cm x 8 cm, with the flap pedicle of 2-4 cm wide strip and 3-5 cm wide fascia.

RESULTS: The pedicle of flap was cut at 3 weeks in 12 patients, and at 4 weeks in 1 patient who had partial avulsion and hemorrhage at 1 week after operation. All flaps survived and incisions at donors and wounds healed by first intention. Eleven patients were followed up 6-36 months (mean, 20 months). The flap color and texture were good; 3 bulky flaps were observed, and satisfactory appearance was achieved after skin flap thinning. After 6 months, the protective sensation recovered in all cases; according to the Hand Surgery Society of Chinese Medical Association evaluation of upper extremity function trial standard for total active motion of the fingers, the results were excellent in 9 cases, good in 1 case, and poor in 1 case.

CONCLUSION: Improved fascia pedicled superficial iliac circumflex artery skin flap can repair serious hand and forearm injury, which is easy-to-operate and less injury at donor site.

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