Free sensate intercostal artery perforator flap for hand soft tissue reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHANG Xingqun ¹ , YAO Yi ¹ , RAO Lei ¹ , QIN Zhenbo ¹ , ZHANG Longchun ² , XU Yibo ² , CHEN Ying ² , YAO Jianmin ² ,  SONG Dajiang ³

1. Department of Hand Surgery and Plastic Surgery, the First People’s Hospital of Yuhang District, Hangzhou Zhejiang, 311100, P.R.China;
2. Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou Zhejiang, 310013, P.R.China;
3. Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China;

Corresponding author：

ZHANG Xingqun, Email: zxqrk@163.com; SONG Dajiang, Email: sdj41@163.com

Keywords：

Hand injury; free flap; intercostal artery; perforator flap; sensory reconstruction

DOI：

10.7507/1002-1892.201904072

Video：

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Objective To investigate the effectiveness of free sensate intercostal artery perforator flap for the hand soft tissue reconstruction.Methods Between March 2010 and September 2015, 19 cases of hand soft tissue defect were repaired with free sensate intercostal artery perforator flap, including 16 males and 3 females, aged from 18 to 53 years, with an average of 35.2 years. The defect was located in the dorsum of the hand in 15 cases and in the palm in 4 cases. The causes of injury were traffic accident injury in 8 cases, hot crush injury in 5 cases, strangulation injury in 4 cases, and avulsion injury in 2 cases. All of them were full-thickness skin and soft tissue defects of hand with exposure of phalanges, tendons, blood vessels, and nerves. The size of defect was 10.0 cm×7.0 cm to 17.0 cm×8.0 cm. There were 12 cases of emergency operation and 7 cases of selective operation. The thickness of flap was 10-25 mm, and the size of the flap ranged from 10.0 cm×7.5 cm to 17.0 cm×8.0 cm. The vascular pedicle of the flap was anastomosed with the snuff nest branch of the radial artery (12 cases), the main radial artery (7 cases), and there accompanying vein, and the intercostal nerve cutaneous branch of the flap was anastomosed with the lateral cutaneous nerve of the forearm. The donor site was closed directly (14 cases) or repaired with medium thickness skin graft (5 cases).Results All of the flaps and skin grafts survived; the wounds in the donor and recipient sites healed by first intention. All 19 patients were followed up 10- 18 months, with an average of 12.7 months. After operation, the appearance and function of the hand recovered well, and there was no flap bloated. The two-point discrimination of the flap was 7-11 mm, with an average of 8.8 mm. Only linear scars left in the patients with direct closure of the donor site. The sensory function of the donor site was not significantly affected, and the hand function recovered satisfactorily. Conclusion Free sensate intercostal artery perforator flap is a valuable and reliable technique for the hand soft tissue defect.

Citation： ZHANG Xingqun, YAO Yi, RAO Lei, QIN Zhenbo, ZHANG Longchun, XU Yibo, CHEN Ying, YAO Jianmin, SONG Dajiang. Free sensate intercostal artery perforator flap for hand soft tissue reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(4): 497-500. doi: 10.7507/1002-1892.201904072 Copy

1.	Song D, Deng X, Chen Y, et al. Thinned chimeric radial collateral artery perforator flap in complex distal thumb reconstruction. Arch Orthop Trauma Surg, 2015, 135(11): 1623-1631.
2.	Tang J, Fang T, Song D, et al. Free deep inferior epigastric artery perforator flap for reconstruction of soft-tissue defects in extremities of children. Microsurgery, 2013, 33(8): 612-619.
3.	张世民, 宋达疆. 穿支皮瓣的发现发展历史与临床启示. 中国修复重建外科杂志, 2017, 31(7): 769-772.
4.	Song D, Pafitanis G, Yang P, et al. Innervated dorsoradial perforator free flap: A reliable supermicrosurgery fingertip reconstruction technique. J Plast Reconstr Aesthet Surg, 2017, 70(8): 1001-1008.
5.	Hamdi M, Van Landuyt K, de Frene B, et al. The versatility of the inter-costal artery perforator (ICAP) flaps. J Plast Reconstr Aesthet Surg, 2006, 59(6): 644-652.
6.	Zelken JA, Chang NJ, Wei FC, et al. The combined ALT-groin flap for the mutilated and degloved hand. Injury, 2015, 46(8): 1591-1596.
7.	Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg, 1984, 37(2): 149-159.
8.	余贵华, 喻爱喜, 陈振光, 等. 带血管桥的多根肋骨瓣修复手掌毁损伤的解剖学研究. 中华手外科杂志, 2005, 21(3): 175-176.
9.	Hamdi M, Spano A, Van Landuyt K, et al. The lateral intercostal artery perforators: anatomical study and clinical application in breast surgery. Plast Reconstr Surg, 2008, 121(2): 389-396.
10.	Iida T, Narushima M, Yoshimatsu H, et al. Versatility of lateral cutaneous branches of intercostal vessels and nerves: anatomical study and clinical application. J Plast Reconstr Aesthet Surg, 2013, 66(11): 1564-1568.
11.	Iida T, Yoshimatsu H, Hara H, et al. Reconstruction of large facial defects using a sensate superficial circumflex iliac perforator flap based on the lateral cutaneous branches of the intercostal nerves. Ann Plast Surg, 2014, 72(3): 328-331.
12.	Iida T, Mihara M, Narushima M, et al. A sensate superficial circumflex iliac perforator flap based on lateral cutaneous branches of the intercostal nerves. J Plast Reconstr Aesthet Surg, 2012, 65(4): 538-540.
13.	Henderson J, Clibbon JJ, Haywood RM. Inadvertent free intercostal artery perforator flaps. J Plast Reconstr Aesthet Surg, 2009, 62(6): e140-e141.

1. Song D, Deng X, Chen Y, et al. Thinned chimeric radial collateral artery perforator flap in complex distal thumb reconstruction. Arch Orthop Trauma Surg, 2015, 135(11): 1623-1631.
2. Tang J, Fang T, Song D, et al. Free deep inferior epigastric artery perforator flap for reconstruction of soft-tissue defects in extremities of children. Microsurgery, 2013, 33(8): 612-619.
3. 张世民, 宋达疆. 穿支皮瓣的发现发展历史与临床启示. 中国修复重建外科杂志, 2017, 31(7): 769-772.
4. Song D, Pafitanis G, Yang P, et al. Innervated dorsoradial perforator free flap: A reliable supermicrosurgery fingertip reconstruction technique. J Plast Reconstr Aesthet Surg, 2017, 70(8): 1001-1008.
5. Hamdi M, Van Landuyt K, de Frene B, et al. The versatility of the inter-costal artery perforator (ICAP) flaps. J Plast Reconstr Aesthet Surg, 2006, 59(6): 644-652.
6. Zelken JA, Chang NJ, Wei FC, et al. The combined ALT-groin flap for the mutilated and degloved hand. Injury, 2015, 46(8): 1591-1596.
7. Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg, 1984, 37(2): 149-159.
8. 余贵华, 喻爱喜, 陈振光, 等. 带血管桥的多根肋骨瓣修复手掌毁损伤的解剖学研究. 中华手外科杂志, 2005, 21(3): 175-176.
9. Hamdi M, Spano A, Van Landuyt K, et al. The lateral intercostal artery perforators: anatomical study and clinical application in breast surgery. Plast Reconstr Surg, 2008, 121(2): 389-396.
10. Iida T, Narushima M, Yoshimatsu H, et al. Versatility of lateral cutaneous branches of intercostal vessels and nerves: anatomical study and clinical application. J Plast Reconstr Aesthet Surg, 2013, 66(11): 1564-1568.
11. Iida T, Yoshimatsu H, Hara H, et al. Reconstruction of large facial defects using a sensate superficial circumflex iliac perforator flap based on the lateral cutaneous branches of the intercostal nerves. Ann Plast Surg, 2014, 72(3): 328-331.
12. Iida T, Mihara M, Narushima M, et al. A sensate superficial circumflex iliac perforator flap based on lateral cutaneous branches of the intercostal nerves. J Plast Reconstr Aesthet Surg, 2012, 65(4): 538-540.
13. Henderson J, Clibbon JJ, Haywood RM. Inadvertent free intercostal artery perforator flaps. J Plast Reconstr Aesthet Surg, 2009, 62(6): e140-e141.

Chinese Journal of Reparative and Reconstructive Surgery

Free sensate intercostal artery perforator flap for hand soft tissue reconstruction

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