Clinical Study On Repair Of Hand Soft Tissue Defect With Superficial Iliac Circumflex Artery Perforator Flap

Objective: To investigate the clinical effect of superficial iliac circumflex artery perforator flap in repairing soft tissue defect of hand.Methods: 22 cases of hand skin and soft tissue defects repaired with superficial circumflex iliac artery perforator flap in our hospital from January2015 to December 2019 were analyzed retrospectively,including 10 females and12 males,aged from 25 to 59 years,with an average of 41 years old.There were8 cases of crush injury,2 cases of hot compression injury,6 cases of mechanical strangulation injury and 6 cases of chainsaw injury.There were 4 cases of distal thumb defect,2 cases of index finger degloving injury,4 cases of ring finger soft tissue defect,3 cases of hand back and finger soft tissue defect,6 cases of hand back soft tissue defect and 3 cases of hand injury.The minimum area of skin and soft tissue defect is 3.0cm×3.0cm,and the maximum area is 14.5cm× 9.5cm.When repairing the wound,the superficial circumflex iliac artery was anastomosed with the terminal branch of the radial artery,and the superficial circumflex iliac vein was anastomosed with the dorsal hand vein.The vascular pedicle was extended by retrograde perfusion.The nerve in the flap was preserved and anastomosed with the superficial branch of the digital nerve or radial nerve in the recipient area.The tendon rupture was fixed with kessler suture,the fracture and dislocation were fixed with Kirschner needle.The donor area was sutured linearly in the first stage.The length of vascular pedicle of the flap was measured,and the appearance and feeling of the flap,complications and discomfort in the donor area were observed after repairing the wound.CDS and CTA were routinely used to locate the perforating branch of superficial iliac circumflex artery before operation.The gold standard was to confirm the existence of perforating vessels during operation.To explore the accuracy of CDS and CTA in detecting superficial circumflex iliac artery before operation.Results: 21 cases of skin flaps survived after operation.The longest vascular pedicle of the flap is 12 cm,the shortest is 6.5cm,and the average length is about 9cm.Vascular lengthening method was used in 6 cases,the longest was 6cm,the shortest was 3cm,and the average 4cm was prolonged.All cases were followed up for 6 to 12 months(Average 8 months).The appearance of the flap was satisfactory,non-bloated and soft.During the follow-up 6months after operation,12 flaps did not carry sensory nerves,of which 3 flaps recovered to S4 and the sensation of the flap recovered in S0-S3+ in 9 cases.The skin flap carried the anterolateral thigh cutaneous nerve in 10 cases,the sensation of the flap recovered to S4 in 8 cases,and the sensation of the flap recovered in S0-S3+ in 2 cases.Compared with the group without nerve,there was a significant difference in the sensation of the skin flap six months after operation(P<0.05).Postoperative complications occurred in 3 cases,including venous crisis and necrosis within 24 hours after skin flap repair.Lymphatic leakage occurred in the donor site in 1 case on the 5th day after operation,and 1patient had a slight sense of traction in the donor area.The wound in the groin donor area healed in the first stage in 21 cases and formed a linear scar after operation,In the preoperative diagnosis of perforating vessels by CDS and CTA,3 cases were not detected by CDS and 1 case was not detected by CTA.The accuracy rate of CDS is 86.4%.The accuracy of focus CTA is 95.5%.There was no significant difference in the accuracy of perforating vessel detection between the two groups(P>0.05).Conclusion:1.The superficial iliac circumflex artery perforator flap is easy to cut,easy to cut thin,can carry sensory nerve,vascular pedicle can be lengthened,the donor area is hidden,the injury is small,and the appearance of the flap is satisfactory after operation.it is an ideal flap for repairing skin and soft tissue defects of the hand.2.There is no significant difference in the accuracy of preoperative perforator location between CDS and CTA,which can provide some theoretical basis for the design of preoperative skin flap.