Clinical application of ulnar artery conjoined perforator flap in repair of multiple fingers damage

Objective To explore the clinical effect of ulnar artery conjoined perforator flap for repair of multiple finger damage. Methods 12 cases of multiple finger injuries were repaired by ulnar artery conjoined perforator flap from March, 2011 to October, 2017 in our hospital, with 4 finger damages in 2 cases, 3 finger damage in 4 cases, 2 finger damage in 6 cases. The position of soft tissue injury were from the palm to the fingertip and the phalanx defect were from proximal to the fingertip. The total area of skin defect was (135.6±12.3) cm2 (6.0 cm×16.0 cm to 6.0 cm×35.0 cm). The total area of skin flaps was (143.5±11.2) cm2 (5.0 cm ×20.0 cm to 3.2 cm×47.0 cm) (bilateral forearm). The perforator flaps of bilateral forearm ulnar artery were used in 5 cases and unilateral in 7 cases. All flaps had more than 2 perforator pedicles. The flaps were designed as long strips and wrapped in wounded phalanges by spiral winding. The perforator artery of the flap was anatomized with the proper digital artery or dorsal metacarpal artery, the accompanying vein was anatomized with the corresponding digital palmary or dorsal metacarpal vein, the superficial vein of the flap was anatomized with the corresponding dorsal digital vein or dorsal metacarpal vein, and the nerve of the flap was anastomosed with the corresponding proper digital nerve or dorsal metacarpal corresponding sensory nerve. The donor site was sutured directly except for 1 case of skin graft, and the curative effect was observed after operation. The follow-up included skin flap sensation, appearance, blood circulation, bone absorption and hand movement function, daily life, recovery of work, etc. The evaluation standard is the upper limb function evaluation trial standard of Hand Surgery Society of Chinese Medical Association. Results All flaps survived. One case had skin necrosis of about 1.5 cm×1.5 cm at the end of the flaps, which was repaired by second-stage suture. All cases were followed up for 6 months to 6.5 years, with an average of 16.7 months. The flaps had good texture, no pigmentation, no swelling, no scar or abrasion on the fingertips, and the two-point discrimination was 6-10 mm, with an average of 8.6 mm. The incidence of bone obsorbtion was 59.4%(19/32) and the mean finger shortening was 0.8 cm. Among them, iliac bone grafting was performed in 5 cases and 6 fingers. The function of holding and pinching of the injured finger was partly restored, there was no significant effect on daily life. The average grip strength of the injured hand reached 60.3% of the healthy side. Evaluation of hand function according to the trial standard of replantation function of severed fingers of Hand Surgery Society of Chinese Medical Association. The motor function of the affected hand was excellent in 2 cases, good in 5 cases, poor in 4 cases and had in 1 case. The excellent and good rate was 58.3%(7/12). The appearance of donor site is acceptable. Conclusions The ulnar artery conjoined perforator flap provides a useful way of thinking and effective operation for repair of patients with multiple finger damage or degloving injury. Key words: Ulnar artery conjoined perforator flap; Multiple finger damage; Repair and reconstruction