gms | German Medical Science

Objectives/Interrogation: To study the clinical effect of free graft of the compound flap of wrist perforator branch of ulnar artery with partial flexor carpi ulnar tendon and / or medial forearm cutaneous nerve for the repair of flexor tendon and / or finger nerve defect in dorsalis digitalis skin and soft tissue.

Methods: From June 2010 to June 2017, 35 patients with 36 fingers dorsal skin and soft tissue with extensor tendon defect and 21 patients with metacarpal skin soft tissue with flexor and / or deep flexor tendon were treated clinically. A patient with a defect of the inherent nerve of the finger. The tendons and (or) nerve defects were transplanted with the ulnar flexor wrist tendon and / or the ulnar artery superior palmar perforating branch flap of the medial forearm cutaneous nerve. The length of ulnar flexor tendon was about 2.0 ~ 5.5 cm with superficial thickness of 0.5 cm. 35 cases (36 fingers with extensor tendon defect) were transplanted to repair the extensor tendon to cover the skin defect. 21 patients with deep flexor tendon and / or finger nerve defect were transplanted to repair. The occurrence of arteriovenous crisis and the principles of management were followed up after operation.

Results and Conclusions: In 56 cases of 57 fingers, 54 fingers flaps survived successfully, and 1 finger appeared arterial crisis, which was relieved after conservative treatment, and later appeared partial necrosis of the distal skin, and scar healed after dressing change. Blisters and purples appeared in 2 fingers, in which 1 finger was partially necrosed, and 1 finger was completely necrosed after dressing change. Skin grafting was performed in the second stage. The flap was followed up for 6 to 24 months,and was similar in color, had no obvious bloated appearance. In the patients with tendon repair, the flexion of the fingers returned to normal or near normal, and the sensory recovery of the nerve repair was s3 / s3 +. The wrist joint movement and flexor muscle strength were not changed.

The ulnar artery has constant cutaneous perforating branches on the palmar side of the wrist, which meets the design requirements, and the skin of this part is similar to the skin texture of the dorsal palm of the finger. It is a good choice to repair the compound tissue defect of the dorsal metacarpal tissue with the free tendon and／or nerve flap of the ulnar artery.