Reconstruction of soft tissue defect in distal hand and foot with modified Quaba flap
10.3760/cma.j.cn441206-20221121-00235
- VernacularTitle:改良Quaba皮瓣修复手和足部远端软组织缺损
- Author:
Erlin CHENG
1
;
Maimaiti XIAYIMAIERDAN
;
Abula ABULAITI
;
Peng REN
;
Wumaierjiang YILIYAER
;
Xin WANG
;
Yusufu AIHEMAITIJIANG
Author Information
1. 新疆医科大学第一附属医院骨科中心显微修复外科，乌鲁木齐 830054
- Keywords:
Quaba flap;
Perforator flap;
Optimal method;
Hand;
Foot;
Soft tissue defect
- From:
Chinese Journal of Microsurgery
2023;46(5):545-551
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical effect of the modified Quaba flap on reconstruction of the soft tissue defects in distal hand and foot.Methods:From August 2013 to March 2022, 36 cases of soft tissue defect in distal hand and foot were reconstructed by the modified Quaba flap in the Department of Microrepair and Reconstruction of Orthopaedic Centre, the First Affiliated Hospital of Xinjiang Medical University. There were 24 males and 12 females, aged 18 to 58 years old with an average age of 35.6 years old. The sizes of defect were 1.5 cm × 0.5 cm - 5.0 cm × 3.0 cm, including 28 in hand and 8 in foot. Of the defects, 26 were traumatic soft tissue defects, 5 were chronic hand infection and 5 were after resection of hand tumour. The sizes of flap employed were 5.0 cm × 1.5 cm - 10.0 cm × 6.5 cm. Method of optimization included: (1) Extended the paddle of propeller flap or made the rotation point being further; (2) Determined the perforator vessel that entered the pedicle, and made the perforating point as the location of rotation hence to maximise a blood flow; (3) Improved the pedicle mobility and reduced the angle of rotation of the flap; (4) The superficial vein in the pedicle was retained in the modified Quaba flap; (5) Properly retained the fascia tissue of the pedicle; (6) "Skinned-tail" design for the pedicle. All patients entered scheduled follow-up reviews at outpatient clinic and by telephone or WeChat interviews. Colour, texture, wound healing, complications at donor site and hand function were evaluated.Results:All flaps survived. The donor sites were directly closed in 27 patients, and skin grafts were applied in 9 patients. All patients were entered postoperative follow-up for 3-36(mean 24) months. All flaps had good colour and texture but with poor sensation. Wounds healed at the first attention. Hand functions(28 cases) were evaluated according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association. Hand function appeared excellent in 23 patients, good in 3 and fair in 2, with an excellent and good rate at 92.9%. Motion of all metacarpophalangeal joints were satisfactory. Flexion of metacarpophalangeal joints ranged from 65° to 90°, with an average of 80°. Dorsal extension ranged from 0° to 20° (mean 8°), without obvious joint pain. Foot functions(8 cases) were evaluated according to hallux metatarsophalangeal-interphalangeal scale of the American Orthopaedic Foot and Ankle Society (AOFAS), 6 patients were in excellent and 2 in good.Conclusion:Modified Quaba flap is easy to harvest and with stable and reliable blood circulation. The optimised methods can extend the length of the paddle of the flap and shorten the rotation point. They are very effective methods in reconstruction of the soft tissue defect in distal hand and foot.
