Abstract:

Objective

To investigate the clinical effects of personalized abdominal pedicled thin flaps in repairing complex wounds of the hand.

Methods

From January 2015 to December 2023， a total of 85 cases with complex hand wounds who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the 910th Hospital of Joint Service Support Unit of PLA， including 48 males and 37 females， aged from 8 to 66（35.25±16.23） years.A total of 199 personalized abdominal pedicled thin flaps were designed according to the conditions of the wounds and abdominal donor sites.Among the 85 cases， wounds were repaired with differently shaped flaps in 74 cases， with flap perforation to create modified bipedicled flaps in 6 cases， and with segmental ligation to narrow abdominal delayed flap pedicle in 5 cases.Flap survival， time for pedicle division， number of surgeries， donor site healing， flap appearance and texture， flap two-point discrimination， hand appearance and function， and scar condition at the donor and recipient sites were observed.

Results

After surgery， all 199 flaps survived successfully.For those repaired with differently shaped flaps， the average time for pedicle division was 13.8 days， the number of surgeries was two， direct suturing was performed in 60 cases （81.08%） and partial suturing combined with skin grafting in 14 cases for the donor sites， and all wounds healed primarily.For those repaired with flap perforation to create modified bipedicled flaps， the average time for pedicle division was 15.5 days，the number of surgeries was 2-4， direct suturing was performed in 2 cases and skin grafting were performed in 4 cases， with all wounds healing well.For those repaired with segmental ligation to narrow abdominal delayed flap pedicle， the average time for pedicle division was 17.0 days， the number of surgeries was 3 or 4， and partial suturing combined with small skin grafting were performed for the donor sites in the 5 cases.Follow-up of 6 months to 6 years indicated that the flaps exhibited good appearance and soft texture， except that 5 flaps were slightly swollen and underwent thinning.At the final follow-up， the two-point discrimination of the flaps was 6 to 14 mm， the excellent and good rate of hand function assessment was 97.65%， and the scars at the donor and recipient sites were mild.

Conclusion

Personalized abdominal pedicled thin flaps， including differently shaped flaps， flap perforation to create modified bipedicled flaps， and segmental ligation to narrow abdominal delayed flap pedicle， have high flap survival rate， short treatment course， good hand appearance and functional recovery， and minimal donor site damage， so it is an effective method for repairing complex hand wounds.

Key words: Hand, Abdomen, Flap, Personalized, Injury and repair