Objective:To investigate the effect of free wrist crease flap based on the superficial palmar branch of radial artery in the treatment of compound tissue defect of dorsal finger.Methods:From January 2015 to June 2019, the clinical data of patients admitted to the Department of Hand Surgery, Xuzhou Renci Hospital with skin, soft tissue and tendon defects of dorsal fingers, with or without bone exposure, were retrospectively analyzed. The free wrist crease flap based on the superficial palmar branch of radial artery was used. For patients with dorsal finger wounds less than 2.5 cm in length, palmaris longus tendon was used in the flap to repair, and the direction of flap incision and dorsal finger repair was consistent. If the length of dorsal finger defect was more than 2.5 cm, the palmaris longus tendon was not carried in the flap. The wrist crease flap based on the superficial palmar branch of the radial artery was harvested, and the free palmaris longus tendon was used to repair the defect along the same incision. The flap was selected according to the left and right wrist donor site flap and rotated 90° counterclockwise or clockwise to cover the dorsal finger wound. The flap survival and texture were followed up after operation. The total active movement(TAM) of fingers was evaluated according to the trial standard for the evaluation of the upper limb function of the Hand Surgery Society of the Chinese Medical Association.Results:A total of 17 patients were enrolled in this study, including 12 males and 5 females. The mean age was 39.5 years (range, 21-65 years). There were 10 cases of left finger and 7 cases of right finger. The area of dorsal finger skin defects ranged from 1.5 cm×1.3 cm to 3.8 cm×2.0 cm, and the area of flap ranged from 1.8 cm×1.5 cm to 4.0 cm×2.2 cm. The patients were followed up for 3 to 48 months, with an average of 16.5 months. All the flaps survived and healed well. The texture of the flap was good, and no obvious swelling was observed. Venous crisis occurred in 1 case 18 hours after operation. The stitches were removed, the edge of the flap was bled, and the flap survived after 10 days. All wrist donor sites were sutured directly and healed well after operation. There was no abnormality in wrist flexion and extension function. The TAM of fingers was rated as excellent in 12 cases, good in 4 cases, and fair in 1 case.Conclusions:The free wrist crease flap based on the superficial palmar branch of radial artery is an alternative method for repairing compound tissue defect of dorsal finger. The recipient flap has no bloated appearance. Finger extension function could be reconstructed. The wound at the donor site is small and could be closed directly.

Objective:To investigate the effect of free wrist crease flap based on the superficial palmar branch of radial artery in the treatment of compound tissue defect of dorsal finger.Methods:From January 2015 to June 2019, the clinical data of patients admitted to the Department of Hand Surgery, Xuzhou Renci Hospital with skin, soft tissue and tendon defects of dorsal fingers, with or without bone exposure, were retrospectively analyzed. The free wrist crease flap based on the superficial palmar branch of radial artery was used. For patients with dorsal finger wounds less than 2.5 cm in length, palmaris longus tendon was used in the flap to repair, and the direction of flap incision and dorsal finger repair was consistent. If the length of dorsal finger defect was more than 2.5 cm, the palmaris longus tendon was not carried in the flap. The wrist crease flap based on the superficial palmar branch of the radial artery was harvested, and the free palmaris longus tendon was used to repair the defect along the same incision. The flap was selected according to the left and right wrist donor site flap and rotated 90° counterclockwise or clockwise to cover the dorsal finger wound. The flap survival and texture were followed up after operation. The total active movement(TAM) of fingers was evaluated according to the trial standard for the evaluation of the upper limb function of the Hand Surgery Society of the Chinese Medical Association.Results:A total of 17 patients were enrolled in this study, including 12 males and 5 females. The mean age was 39.5 years (range, 21-65 years). There were 10 cases of left finger and 7 cases of right finger. The area of dorsal finger skin defects ranged from 1.5 cm×1.3 cm to 3.8 cm×2.0 cm, and the area of flap ranged from 1.8 cm×1.5 cm to 4.0 cm×2.2 cm. The patients were followed up for 3 to 48 months, with an average of 16.5 months. All the flaps survived and healed well. The texture of the flap was good, and no obvious swelling was observed. Venous crisis occurred in 1 case 18 hours after operation. The stitches were removed, the edge of the flap was bled, and the flap survived after 10 days. All wrist donor sites were sutured directly and healed well after operation. There was no abnormality in wrist flexion and extension function. The TAM of fingers was rated as excellent in 12 cases, good in 4 cases, and fair in 1 case.Conclusions:The free wrist crease flap based on the superficial palmar branch of radial artery is an alternative method for repairing compound tissue defect of dorsal finger. The recipient flap has no bloated appearance. Finger extension function could be reconstructed. The wound at the donor site is small and could be closed directly.

Objective To analyze the characteristics of medial sural artery perforator (MSAP) flap, and to ex-plore the practicality of repair of small and medium-sized defects of dorsum pedis with the flap. Methods Between March, 2012 to December, 2015, 12 patients with variable defects of 4.0 cm×3.0 cm to 4.0 cm×6.0 cm underwent MSAP flap reconstruction. There were 7 males and 5 females, aged from 19 to 49 years (mean, 32 years). The disease causes were crush injury in 6 cases, machine saw injury in 5 cases, and hot crush injury in 1 case. The size of flaps ranged from 4.0 cm × 5.0 cm to 5.0 cm×7.0 cm. All of the donor site was sutured directly. Postoperative follow up was done termly. Results All 12 flaps survived. The flap was similar to the surrounding normal skin, and all patients returned to ambulation. Eleven cases survived without a hitch, the other 1 of venous congestion was salvaged by venous thrombectomy and reanastomosis. Fol-lowed-up 5-24 months postoperative, the color of the flap was similar to the surrounding skin. All patients recovered walk-ing and shoe wearing function. The calf residual linear scar. Conclusion The MSAP flap provides thin soft tissue cover-age, enabling good functional recovery after defect reconstruction dorsum of forefoot, show the evident advantages.

Objective:To explore the method and effect of repairing fingertip defect and soft tissue defect in donor area by relay flap with suture nerve.Methods:From January 2017 to May 2019, 11 cases of fingertip defects were repaired with reverse island fascial pedicle flap of dorsal digital artery sutured with nerve, with a flap area of 0.6 cm×1.2 cm-1.6 cm×2.0 cm, and the flap donor area was repaired with dorsal metacarpal artery cutaneous branch flap. The patients were followed-up by outpatient, reexamination and WeChat interviews.Results:Twenty-two flaps of 11 cases survived completely and the wound healed in stage I. The postoperative follow-up ranged from 3 to 36 months, with an average of 13 months. The flap and pedicle were not bloated, the shape of finger was satisfactory, the texture was soft, and the skin color was close to the skin of finger. Sensory recovery≥S 3. The TPD of the flap was 6-11 mm, with an average of 8.4 mm. Hand function was evaluated according to the Trial Standard of Upper Limb Function Evaluation of Chinese Medical Association: excellent in 10 cases and good in 1 case. The patients were satisfied with the repair effect and resumed their daily life and work. Conclusion:This operation is simple, does not need to sacrifice the main blood vessels and nerves, can restore the good shape and sensction of the affected finger, with the activity close to normal. It is an effective method to repair the fingertip defect.

Objective:To summarise the clinical efficacy of free deep inferior epigastric artery perforator flap (DIEPF) in repairing large wounds in upper limb.Methods:From June 2016 to March 2022, free DIEPF repair surgery were performed for 9 cases with large defects in elbow, forearm and wrist in the Department of Hand Surgery, Xuzhou Renci Hospital. The patients were 3 males and 6 females at 36-65(average 50) years old. The sizes of defect ranged from 6.0 cm×7.0 cm to 25.0 cm×33.0 cm. Seven defects combined with radius-ulnar fracture, 4 with wrist fracture, 4 with metacarpal fracture and 1 with humerus fracture. All defects had various degrees of injuries of tendon, blood vessel and nerve. A total of 10 flaps were harvested, and the size of flaps were 7.0 cm×8.0 cm-12.0 cm×35.0 cm. Vessels in 7 flaps of 6 patients were anastomosed with unilateral vascular pedicles and 3 with bilateral vascular pedicles. End-to-end arterial anastomosis was performed on 1 flap, and the other 9 flaps of 8 patients had end-to-side arterial anastomoses. End-to-end vein anastomoses were performed on all flaps. Umbilical reconstruction was performed at the abdominal donor site for 3 patients, and all donor site wounds were closed in stage I surgery. Scheduled outpatient and WeChat follow-up were made after surgery.Results:Nine flaps in 8 patients survived successfully. Partial skin necrosis occurred in 1 flap and repaired by skin grafting. Follow-up lasted for 6 to 60 months(12 months in average). At the last follow-up, the colour of the flaps was found being similar to the surrounding skin with mildly bloated and soft in texture. Sensation of the flaps recovered to S 2 in 5 patients, and not detected in 4 cases. Conclusion:The free DIEPF has a relatively constant perforator and the flap can be used for repairing a large area of defect. The donor site wound can be closed in Ⅰ stage surgery. Free DIEPF is suitable for repair of large upper limb wounds.