Flow-through anterolateral thigh perforator flap with fascia lata for repairing dorsal wounds of the hand and foot with extensor tendon defects / 中华创伤杂志

ABSTRACT

Objective:To investigate the clinical effect of flow-through anterolateral thigh perforator flap with fascia lata for repairing dorsal wounds of the hand and foot with extensor tendon defects.Methods:A retrospective case series study was conducted to analyze the clinical date of 14 patients with hand and foot wounds associated with extensor tendon defects admitted to Ruihua Affiliated Hospital of Soochow University from January 2015 to December 2019. There were 13 males and 1 female，aged 10-57 years［（39.2±13.4）years］. The wounds were all single with the area of 10 cm×4 cm to 23 cm×12 cm，including 8 wounds on the back of the hand and 6 wounds on the back of the foot. There was 1 patient accompanied with 1 tendon defect，10 with 4 tendon defects and 3 with 5 tendon defects，with the length of tendon defects ranging from 2.0 to 6.0 cm［（3.8±1.4）cm］. The dimension of flaps ranged from 12 cm×5 cm to 23 cm×13 cm，with the fascia lata from 11 cm×5 cm to 20 cm×7 cm. The deficient extensor tendons were repaired with the fascia lata and vascular pedicles were anastomosed by flow-though. A bilobed flap was harvested in 3 patients and a single flap in 11 patients. Donor sites were sutured directly. The survival of the flap and healing of the donor area were detected after operation. The extremity revascularization and shape and sensation recovery of the flap were measured at the last follow-up. The upper extremity functional evaluation standard set up by Hand Surgery Society of the Chinese Medical Association and Maryland foot functional score were used to evaluate the hand and foot function before operation and at the cast follow-up，respectively. The donor site complications and performance of tendon release or flap thinning in the second stage were recorded.Results:All patients were followed up for 8-30 months［（15.3±6.2）months］. All flaps survived successfully，with wounds and thigh donor areas healed by first intension. No significant effect of revascularization was observed on recipient sites，and acceptable cosmetic outcomes and sensation recovery of the flap were achieved at the final follow-up. For patients with dorsal wounds of the hand，the extensor function recovered in different degrees，and the flexion activities of the fingers were not limited. The total active movement was 180°-250°［（226.3±21.7）°］at the last follow-up，compared to preoperative 110°-170°［（145.6±13.2）°］（ P<0.01）. According to the upper extremity functional evaluation standard，the function was excellent in 4 patients，good in 2 and fair in 2. For patients with wounds of the foot，the flexion and extension function was good，with no obvious deformity of toes，and the Maryland foot functional score ranged from 60 to 92 points［（76.0±12.7）points］at the last follow-up，significantly improved from preoperative 18-45 points［（27.4±7.8）points］（ P<0.01），including excellent results in 2 patients，good in 3 and fair in 1. Only linear scars were left in the thigh donor area，and there was no discomfort such as scar contracture or pain. Four patients underwent skin flap thinning at 4-8 months after operation and none underwent a tenolysis. Conclusion:Repair of dorsal wounds with extensor tendon defects of the hand and foot by flow-through anterolateral thigh perforator flap with fascia lata can reduce interference to recipient sites and repair wounds and extensor tendons simultaneously，which can obtain good flexion and extension function and minor damage to the donor area.