One-stage reconstruction of complex soft tissue defects in the hands using multidigit, chimeric, lateral arm, perforator flaps

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2019-06, Vol.72 (6), p.902-908
• Main Authors: Ye, Shu-Ming, Yu, Yue, Jing, Jue-Hua, Zhou, Yun, Zhang, Ji-Sen, Teng, Xiao-feng, Xu, Chun-Gui, Cheng, Wen-dan, Li, Zi-yu, Xu, You-Jia
• Format: Article
• Language: English
• Subjects: Adult; Donor site morbidity; Female; Fingers - physiopathology; Fingers - surgery; Free Tissue Flaps; Free tissue transfer; Hand Injuries - physiopathology; Hand Injuries - psychology; Hand Injuries - surgery; Humans; Lateral arm flaps; Male; Middle Aged; Multidigit injury; Outcome Assessment, Health Care; Patient Satisfaction; Perforator Flap; Postoperative Complications - diagnosis; Postoperative Complications - physiopathology; Postoperative Complications - psychology; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - instrumentation; Reconstructive Surgical Procedures - methods; Recovery of Function; Soft Tissue Injuries - physiopathology; Soft Tissue Injuries - psychology; Soft Tissue Injuries - surgery; Trauma Severity Indices
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2018.12.034

To describe our experience using microsurgically fabricated, multilobed, chimeric, lateral arm (LA) flaps to reconstruct hand injuries with complex, multidigit, soft tissue defects and to evaluate the morbidity and esthetic and functional outcomes of the donor sites. We performed a single center, retrospective analysis of 21 patients with hand wounds treated from October 2013 to February 2016. All patients underwent reconstruction using multilobed, chimeric, free, LA flaps. A self-reported questionnaire was used to assess donor site morbidity and satisfaction with the esthetic and overall functional result. Outcome measures were the Disabilities of the Arm, Shoulder and Hand (DASH) score, static 2-point discrimination score, and visual analogue scale. The study included 21 patients (20 males and 1 female), with an average age of 32.14 years (range 18–45 years), who sustained traumatic injuries in road traffic accidents (n = 2) or industrial devices (n = 19). The average DASH score was 28.25 ± 2.3, the average 2-PD score was 7.20 ± 1.30, and the average visual analogue scale (VAS) was 0.38 ± 0.40. All 21 patients had sensory disorders at the donor site. Postoperative donor site complications comprised wound dehiscence (n = 1) and hematoma (n = 3). The patient-rated satisfaction score for the donor site was 5.40 ± 0.90, and 70% of the patients would undergo the same surgery again. Microsurgical fabrication of multilobed, chimeric, LA flaps can exhibit sensory recovery and minimal pain but may cause hematoma and sensory disorders at the donor site. The flaps are a viable alternative for the reconstruction of complex, multidigit, soft tissue defects of the hands.