Department of Hand and Microsurgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410000, China.
J Orthop Surg Res. 2024 Sep 2;19(1):533. doi: 10.1186/s13018-024-05024-z.
The reconstruction of complex wounds of the hand still has challenges in achieving aesthetic, functional and sensory recovery. We presented our experience of using the polyfoliate and chimeric radial collateral artery perforator flaps (RCAPF) to repair complex hand defects, aiming to explore the feasibility of special-form RCAPFs in hand coverage and enhance the comprehension of their respective indications.
From June 2014 to March 2021, 26 cases (19 males and 7 females, mean 44.4 years) underwent defect and sensation reconstruction of their hands with special-form RCAPFs, which manifested as multiple adjacent or irregular single wounds and composite tissue defects complicated with a degree of nerve injury. The clinical effects of the free RCAPFs were evaluated by integrating the postoperative and long-term follow-up outcomes of all cases.
Altogether 8 polyfoliate flaps, 17 chimeric flaps and 1 polyfoliate-chimeric flap were harvested. Of them, 23 flaps survived uneventfully in one stage. Venous congestion occurred in 3 cases, two of which survived through vascular exploration and another one was finally repaired by the contralateral RCAPF. The follow-up results showed that the appearance of both the recipient and donor sites mostly recovered satisfactory. All the bone flaps properly healed. The BMRC sensory evaluation results of all skin flaps were S4 in 8 flaps, S3 in 18 flaps, and S2 in 9 flaps.
The free RCAPFs can be designed in various forms with a reliable blood supply, contributing to reconstructing simple and multiple wounds of the hand with or without bone defects and dead space.
手部复杂创面的修复仍然面临着在实现美观、功能和感觉恢复方面的挑战。我们介绍了使用多叶和嵌合桡侧副动脉穿支皮瓣（RCAPF）修复复杂手部缺损的经验，旨在探讨特殊形式 RCAPF 在手部覆盖中的可行性，并加深对其各自适应证的理解。
自 2014 年 6 月至 2021 年 3 月，26 例（男 19 例，女 7 例，平均年龄 44.4 岁）患者手部存在多个相邻或不规则单个创面及复合组织缺损，伴不同程度神经损伤，采用特殊形式 RCAPF 进行缺损和感觉重建。综合所有病例的术后和长期随访结果，评估游离 RCAPF 的临床效果。
共切取 8 个多叶皮瓣、17 个嵌合皮瓣和 1 个多叶-嵌合皮瓣。其中 23 个皮瓣一期顺利成活，3 个出现静脉淤血，2 例经血管探查后存活，另 1 例最终通过对侧 RCAPF 修复。随访结果显示，受区和供区外观均基本恢复满意，所有骨瓣均愈合良好。所有皮瓣的 BMRC 感觉评估结果均为 8 个皮瓣 S4，18 个皮瓣 S3，9 个皮瓣 S2。
游离 RCAPF 可设计成多种形式，具有可靠的血供，有助于重建有或无骨缺损和死腔的简单和多发手部创面。
