Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2026 Jan 20;42(1):57-65. doi: 10.3760/cma.j.cn501225-20241015-00390.
ABSTRACT
Objective: To explore the effects of ultrathin inguinal flap free transplantation in repairing hand and foot wounds. Methods: This study was a case series study. From January 2021 to March 2024, 18 patients (14 males and 4 females, aged 19 to 66 years) with skin and soft tissue defects of hands and feet accompanied by tendon and/or bone injuries and exposure were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital. A total of 21 wounds were involved, including 12 on hands and 9 on feet. The area of skin and soft tissue defects after debridement was 5.0 cm×2.5 cm to 16.0 cm×5.0 cm. Using the reverse dissection method, ultrathin inguinal flaps containing the subdermal vascular network were obtained with the pure skin perforator as the center. The size of flaps was 6.0 cm×3.0 cm to 17.0 cm×6.5 cm. Among them, 15 flaps were based on the superficial circumflex iliac artery as the vascular pedicle, 5 flaps were based on the common trunk of the superficial circumflex iliac artery and the superficial epigastric artery as the vascular pedicle, and 1 flap was based on the dual vessels of the superficial circumflex iliac artery and the superficial epigastric artery as the vascular pedicle. The flaps were transferred to the recipient wounds, and the arteries and veins of the vascular pedicles were end-to-end anastomosed with the recipient arteries and veins, and then the wounds were closed. The donor site wounds were sutured with tension reduction. During the operation, the thickness of flaps, the diameter of arterial anastomosis in vascular pedicle, the number of pure skin perforators carried, and the distance between adjacent pure skin perforators in multi-perforator flaps were measured and recorded. Postoperatively, the survival of the flaps, the occurrence of complications, as well as the healing of the donor site wounds were observed. During follow-up, the repair of the recipient areas was observed. At the last follow-up, the total active motion (TAM) was used to evaluate the function of the affected fingers, and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) was used to score the function of the affected feet. The Likert scale was used to evaluate the patients' satisfaction with the therapeutic effect. Results: The thickness of flaps of patients was 0.2 to 0.5 cm, with an average of 0.4 cm; the diameter of arterial anastomosis in vascular pedicle was 0.5 to 1.2 mm, with an average of 0.7 mm; 7 flaps each carried one pure skin perforator, 6 flaps each carried two pure skin perforators, and 8 flaps each carried three pure skin perforators. The distance between adjacent pure skin perforators in multi-perforator flaps was 0.8 to 3.5 cm, with an average of 1.7 cm. Postoperatively, one flap showed small area of necrosis, which survived after debridement and suture; the remaining flaps survived smoothly. Three affected fingers had blood supply disorder at the distal end, and all survived after arterial recanalization. One donor site wound healed poorly due to high local tension and healed after debridement and suture, and the remaining donor site wounds healed smoothly. During the 6 to 35 months of follow-up, the flaps were soft and elastic. Two flaps were slightly swollen and underwent thinning treatment 3 to 5 months after surgery. At the last follow-up, the TAM of 10 affected fingers were excellent, and two were good, the AOFAS-AHS score of 9 affected feet was 99 to 100 points, and all 18 patients were very satisfied with the effects. Conclusions: The ultrathin inguinal flap has the advantages of thin thickness, rich blood supply, and reliable harvesting method. Its application in repairing hand and foot wounds after burns and trauma can achieve ideal aesthetic and functional results, with a low rate of secondary revision, and it is worthy of clinical promotion and application.
PMID:41611289 | PMC:PMC12835845 | DOI:10.3760/cma.j.cn501225-20241015-00390