Paraumbilical Perforator Flap: A Good Choice for the Repair of the Deep Soft Tissue Defects in the Hand and Forearm

Abstract

Objective: Severe trauma to the hand or forearm often results in the deep soft tissue defect with the exposure of tendon or bone, which needs to be repaired by skin flaps. In this study, we introduced the use of paraumbilical perforator flap in the repair of such defects, and discussed its advantages and disadvantages.Methods: From Jan. 2006 to Dec. 2016, 14 patients with deep soft tissue defects in the hand and forearm were admitted into our clinic. The defects were caused by hot-crush injury (n=2), electrical injury (n=4), severe burn (n=2), crush injury (n=3), and avulsion injury (n=3). After admission, the patients underwent the debridement, vacuum suction, and skin graft to repair partial wound. The deep defects with the exposure of tendon and bone were repaired by paraumbilical perforator flap finally.Results: All of the 14 flaps survived after the transfer in the first-stage operation. The width of the flap's pedicle ranged from 6 cm to 8 cm, and the length ranged from 16 cm to 20 cm. 1620 days later, the second-stage operation was done to divide the pedicle. After the division, 11/14 of the flaps survived well. The remaining 3/14 flaps had the partial necrosis of the margin, which healed with changing dressing. In the follow-up period, most of the flaps had satisfying appearance. 2 flaps were bulky and thinned by surgery. Conclusions:The paraumbilical perforator flap has reliable blood supply, good texture, sufficient area, and is convenient to transfer. It's an ideal choice for the repair of the deep soft tissue defect in the hand and forearm.

Two Perforators Improve the Extent and Reliability of Paraumbilical Flaps for Upper Limb Reconstruction

“…11 Jim Wang et al in a series of 14 patients reported a flap of mean dimensions of 6 cm to 8 cm in width and 16 cm to 20 cm in length. 12 In a series of 12 patients, flap dimensions ranging from 6 cm to a maximum length of about 18 cm were used. 13 Most of his flaps extended up to the anterior axillary line, with only five extending to the mid axillary line.…”

Lateral Thoracodorsal Flap Revisited: An Underappreciated Workhorse

“…11 Jim Wang et al in a series of 14 patients reported a flap of mean dimensions of 6 cm to 8 cm in width and 16 cm to 20 cm in length. 12 …”

Kết quả bước đầu sử dụng vạt da cuống liền nhánh xuyên động mạch thượng vị dưới sâu “mỏng” trong tạo hình tổn thương vùng cổ bàn tay.

“…Một số tác giả gọi các nhánh xuyên này là nhánh xuyên hàng trong và hàng ngoài. Ngoài ra, một số tác giả gọi những nhánh xuyên chui qua cân ở thẳng bụng ở gần rốn và cung cấp máu cho mô dưới da liền kề là nhánh xuyên cạnh rốn hoặc nhánh xuyên cạnh đường giữa hay nhánh xuyên cạnh cơ [1], [6], [7]. Chính vì tính phong phú của nhánh xuyên động mạch thượng vị dưới sâu nên có thể dễ dàng lựa chọn một nhánh xuyên để thiết kế vạt chỉ bằng cách sử dụng siêu âm Doppler cầm tay để dò tín hiệu mạch máu.…”

“…Để bảo đảm vạt sẽ sống tốt sau cắt cuống, chỉ được cắt cuống vạt sau khi kẹp cuống mà tình trạng cấp máu cho vạt vẫn bảo đảm tốt (vạt không bị thiếu máu tái nhợt hay ứ máu gây xung huyết), có thể cắt cuống vạt sau 24 giờ sau khi kiểm tra sự cấp máu từ nền ghép cho kết quả tốt [4], [6].…”