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[Free sensate intercostal artery perforator flap for hand soft tissue reconstruction].

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.