| Objective: Studying and comparing the indications,complications,skin flap recovery and limb function recovery of ALTPF and APSF grafts for repairing soft tissue defects of the hand,to further elaborate the advantages and clinical effects of ALTPF and APSF transplantation in the repair of soft tissue defects of the hand.Methods: Collect the cases from January 2014 to June 2017,the patients were treated with Anterolateral Thigh perforator flap for repair of hand soft tissue defect in ALTPF group and APSF group in which Abdominal Pedicle Skin flaps was used to repair soft tissue defect of hand.In ALTPF group,there were 38 patients with 20 males and 18 females,aged 16 to 51 years,with an average age of(30.61±9.52)years.There were 13 cases of mechanical crush injury,14 cases of mechanical heat pressing injury,7 cases of traffic accident injury and 4 cases of smashing injury.The area of defect area was 4cm x 7cm~13cm x 21 cm,and 14 cases were accompanied with metacarpal fracture.APSF group: a total of 37 patients with 21 males and 16 females,age 17 to 54 years,with an average age of(32.57±9.57)Years;There were 11 cases of mechanical crush injury,16 cases of mechanical heat pressing injury,4 cases of traffic accident injury and 6 cases of smashing injury.The area of the defect was 5cm x 6cm ~12cm x 19 cm.Methods of restoration of donor areas: ALTPF group: The wound whose width was less than 8 cm was closed by tension reduction suture.The middle thickness skin grafts were used to repair the wounds whose width was more than 8 cm.APSF group: The wound whose width was less than 10 cm after tension-reduction suture;Moderate thickness skin grafts were used to repair the wounds whose width was more than 10 cm.Postoperative complications,flap recovery,movement and sensory recovery of the two groups were evaluated.Results:1.Postoperative complications of two groups: In the ALTPF group,there were 2 cases of vascular crisis and 1 case of skin flap infection in the recipient area after operation.One case showed 1.5cm necrosis of the edge of the flap 3 days after operation,which healed after dressing change.The rate of complication was 10.53%.In the APSF group,there were 2 cases of vascular crisis,1 case of infection,3 cases of delayed healing caused by fat liquefaction and 5 cases of flaps bloated.The rate of complication was 29.73%.2.Long-term follow-up evaluation of postoperative skin flap: In the group of ALTPF,38 cases were well evaluated in 30 cases,good in 7 cases,and 1 fair case,with a good rate of 97.37%.In the group of APSF,18 cases were superior in 37 cases,good in 10,fair in 7 and poor in 2,with a good rate of 75.68%.3.Sensory recovery of affected limbs: ALTPF group: Among the 38 patients,the evaluation was excellent in 26 cases,good in 9 cases,fair in 1 case and poor in 1 case,with the good rate of 92.11%.APSF group: Among the 37 patients,the evaluation was excellent in 16 cases,good in 11 cases,fair in 5 cases and poor in 5 cases,with the good rate of 75.68%.4.Recovery of motor function of affected limbs: ALTPF group: Among the 38 patients,the evaluation was excellent in 29 cases and good in 9 cases,with a good rate of 100%.APSF group: Among the 37 patients,the evaluation was excellent in 21 cases,good in 15 cases,and in 1 cases,with a good rate of 97.30%.Conclusion:(1)Transplantation of ALTPF and APSF to repair soft tissue defect of hand were both reliable,and there was no significant difference in the recovery of the motor fun ction in the back of the hand;(2)The postoperative complication rate of ALTPF group was significantly lower than that of APSF group,which proved that the safety of Anterolateral Thigh Perforator Flap was better than that of Abdominal Pedicle Skin Flaps;(3)The ALTPF group had better sensory recovery and higher flap evaluation,which was suitable f or patients with fine functional requirements. |
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