SỬ DỤNG VẠT BÌ CẲNG TAY NGOÀI CUỐNG NGOẠI VI CHE PHỦ KHUYẾT HỔNG MÔ MỀM CỔ BÀN TAY: BÁO CÁO MỘT SỐ CA LÂM SÀNG

Abstract

Background: The soft tissue defect of the wrist and the hand often exposed important structure easily, so it need to be covered early by  good mterials. In the past, radial forearm fasciocutaneous flap (Chinese’s flap) are widely used to cover this area. However, Chinese’s flap has two disadvantages, to sacrifice radial artery (RA) and to have a bad scars. The distally based lateral antebrachial neurofasciocutaneous flap (DLANF) flap is an other choice for soft tissue coverage of wrist and hand defects with some advantages such as: RA preserved , good material, reliable, and it can cover the large areas. But clinical data of DLANF has not much. Therefore, a clinical study is required to assess the results of using of DLANF for soft tissue coverage of wrist and hand defects. Materials and method: A case series, prospective study design was used. From september, 2020 to september 2022, in the Departement of Microsurgery and Reconstruction at HTO Ho Chi Minh City, 8 patients with 8 flaps were raised for covering soft tissue of wrists and hands defects, exposing of tendons, bone. Patients have been monitored at least 2 months for evaluating the condition of flaps. Results: All flaps survived. However, marginal necrosis  was observed in one case and one flap  suffered from venous congestion followed by distal superficial necrosis; nevertheless, it completely healed after 20 days. Five patients had the donor site directly closed. The remaining three patients  required split- thickness skin grafts. The flaps dimension were as large as 7x8 cm. This flap can cover many sides of wrist and hand: radial side (3 cases), dorsal side (2 cases), volar side (2 cases) and volar of wrist (1 case). No patient suffered from a painful neuroma. No patient complained of any sensory deficit. Discussion: The DLAN flap provided reliable coverage of soft tissue defects of the hand and wrist. The flap can be raised with large dimensions. DLAN flaps are easy to dissect,  they are reliable and versatile, and major vessels like the radial, ulnar, and posterior interosseous  arteries  are  preserved. In the majority of cases, the donor site may be closed primarily.