CLINICAL APPLICATION OF LATERAL ARM LOBULATED FLAPS TO REPAIR MULTIPLE SOFT TISSUE DEFECT OF HAND

Abstract To explore the effectiveness and operation of repairing multiple soft tissue defects in hands with lateral arm lobulated flaps. Between October 2013 and September 2015, 13 cases of multiple soft tissue defects in the hand with tendon or bone exposure were treated with lateral arm lobulated flaps. All patients were males with average age of 28 years (range, 23-45 years). Defects were caused by penetrating injury in 7 cases, traffic accident injury in 3 cases, and hot-crush injury in 3 cases. Six patients had skin defect of the left 2 fingers after opening finger amputation, and 7 patients had skin defect of the palm and the back after hand injury. The size of skin defects ranged from 6 cm x 5 cm to 9 cm x 6 cm. All patients underwent emergency debridement and two-stage repair; the duration from injury to operation was 5-9 days (mean, 7 days). The size of flap was 6 cm x 5 cm-9 cm x 6 cm. All flaps survived completely, with no vascular crisis. Primary healing was obtained at donor and recipient sites, and the grafted skin survived. All cases were followed up 3-24 months (mean, 12 months). The appearance and texture of the flaps were similar to those of adjacent skin. Bulky flap was observed in 4 cases, and second stage operation was performed to make the flap thinner at 3 months after operation. The sensation of flap reached S₃-S₄. The lateral arm lobulated flap based on the radial collateral artery has constant vascular anatomy, easy-to-harvest, and large rotation angle. It is an effective procedure to repair small and medium size skin defects of the hand with satisfied texture and sensory recovery.