To explore the clinical effects of repairing middle and small skin defects of hand by using free upper arm lateral perforator flap.

From April 2012 to May 2018, 19 cases of hand soft tissue defects with deep tissue exposure enrolled in Department of Hand, Foot and Ankle Surgery, Third Clinical Medical College of Inner Morgolia Medical University were repaired with free upper arm lateral perforator flap. There were 17 males and 2 females with a mean age of (27±4) years (range, 23-45 years), 8 cases on the left side and 11 cases on the right side; The causes included 12 cases of machine crush injury, 6 cases of electric shock and burn, and 1 case of traumatic scar contracture. The repaired area included 7 cases of index finger, 3 cases of middle finger, 6 cases of fingers and back of the hand, 2 cases of palm and dorsal side, 1 case of Hukou area; combined metacarpal and phalangeal fractures in 10 cases, extensor and flexor tendon ruptures in 12 cases, and emergency debridement and fracture reduction and Kirschner wire internal fixation were performed with broken tendon anastomosis, with a defect area of 2.0 cm×4.0 cm to 5.0 cm×9.5 cm. After 6-9 days, flap repair was performed, and the flap size ranged from 3.5 cm×5.5 cm to 7.0 cm×11.0 cm. The color, temperature, swelling and capillary reflux of the flap were closely observed after operation. Routine, anticoagulant, antispasmodic treatment and plaster immobilization were given for 3 weeks. Functional rehabilitation was started and regular follow-up was performed.

All 19 skin flaps in this group survived, and 15 patients were followed up for 3-17 months (mean, 6 months). According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medical Association: the results were excellent in 13 cases, good in 2 cases, S3+ in 9 cases, S3 in 5 cases, S2 in 1 cases. The two-point discrimination was 6-13 mm. The skin flap of the wound repair area had good texture and ideal appearance. The donor area was directly sutured except for one case of skin grafting, with no significant complications and no effect on limb movement.

The lateral arm free perforator flap has constant vessels anatomy, reliable blood supply, easy operation, moderate thickness of the flap, good recovery, beautiful appearance, and minor trauma to the donor area. It is an effective and feasible method to repair moderate and small areas soft tissue defects (<15.0 cm) of the hand.