Repair of large soft tissue defects of the thenar and dorsal thumb with snuffbox perforator flap of radial artery / 中华整形外科杂志

ABSTRACT

Objective@#To investigate the clinical outcomes of snuffbox perforator flap of radial artery to repair large soft tissue defects of the thenar and dorsal thumb.@*Methods@#From June 2012 to March 2017, a total of 18 cases with large soft tissue defects of the thenar and dorsal thumb were hospitalized in the Second Hospital of Tangshan. There were 13 males and 5 females, with an average age of 39 years (range, 17 to 64 years). The right hand was involved in 14 cases and the left in 4 cases. There were 5 cases of thenar defect, 7 cases of dorsal thumb defect and 6 cases of thenar combined with dorsal thumb defect. The tendon and / or bone were exposed in all 18 cases. The size of the wounds after debridement ranged from 2.5 cm × 3.5 cm to 4.5 cm × 6.0 cm. The snuffbox perforator flap was designed to repair the defect based on the pivot point of snuff box and the axis line from styloid process of radius to capitulum of radius. Four cases with extensor tendon defects of the thumbs were grafted with a section of brachial radial tendon. The dimension of the flaps ranged from 2.8 cm × 3.8 cm to 5.0 cm × 6.8 cm. The observation indexes included blood supply and appearance of the flap, the total activity of flexion and extension (TAM) of the injured thumb, the angle of the first web span and the satisfaction of the patients.@*Results@#All flaps survived uneventfully. The donor area of forearm was directly closed in 16 cases, and the remaining wound in 2 cases was repaired by free skin graft. All the cases were followed up for 8 to 16 months (mean, 12 months). The good appearance of the flaps with soft texture was obtained. The average values of TAM of the injured thumbs and the first webs were 139°and 96°, respectively. They were excellent in 15 cases and good in three cases for TAM, and excellent in all cases for the first webs. 10 patients were very satisfactory with flap appearance and thumb function and the rest was satisfactory.@*Conclusions@#The snuffbox perforator flap of radial artery provides a reliable and simple technique with constant blood supply and minimal donor-site cost, which could be an ideal option for repairing large soft tissue defects of the thenar and dorsal thumb with extensor tendon defects of the thumbs.