[Effectiveness of retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve in treatment of hand defect]

Ailing Xie, Jian Zhang, Aidong Lu, Jianxin Yuan, Bin Wang, Huanyou Yang, Jianfeng Zhang, Hui Wang
Chinese Journal of Reparative and Reconstructive Surgery 2014, 28 (12): 1498-501

OBJECTIVE: To explore the effectiveness of retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve in the treatment of soft tissue defect of the hand.

METHODS: Between October 2011 and December 2013, 17 cases of skin and soft tissue defects of the hands were treated. There were 8 males and 9 females, aged 23-62 years (mean, 44 years). Of them, defect was caused by trauma in 13 cases, by postoperative wound after degloving injury in 2 cases, and by resection of contracture of the first web in 2 cases; 13 cases of traumas had a disease duration of 2-6 hours (mean, 3.5 hours). The defect sites located at the back of the hand in 5 cases, at the radial side of the palm in 4 cases, at the first web in 2 cases, at the palmar side of the thumb in 4 cases, and at the radial dorsal side of the thumb in 2 cases. The bone, tendons, and other deep tissue were exposed in 15 cases. The defect size varied from 3 cm x 3 cm to 12 cm x 8 cm. The size of the flaps ranged from 3.6 cm x 3.6 cm to 13.2 cm x 8.8 cm. The lateral cutaneous nerve of the forearm was anastomosed with the cutaneous nerve of the recipient sites in 9 cases. The donor sites were repaired by free skin graft or were sutured directly.

RESULTS: The other flaps survived, and obtained healing by first intention except 2 flaps which had partial necrosis with healing by second intention at 1 month after dressing change. The skin graft at donor site survived, and incisions healed by first intention. All patients were followed up 5-30 months (mean, 12 months). The flaps had good color and texture. Flap sensory recovery, of S2-S3+ was obtained; in 9 cases undergoing cutaneous nerve flap anastomosis, the sensation of the flaps recovered to S3-S3+ and was better than that of 8 cases that the nerves were disconnected (S2-S3). The patients achieved satisfactory recovery of hand function. Only 2 cases had extended limitation of the proximal interphalangeal joint. At last follow-up, according to the Chinese Medical Society of Hand Surgery function evaluation standards, the results were excellent in 15 cases and good in 2 cases.

CONCLUSION: Retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve is an effective way to repair skin defects of the hand, with the advantages of reliable blood supply and simple surgical procedure.

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