Reconstruction of injured soft tissues of hands by distally based radial artery perforators flaps

Backgroun and In acute extensive injuries of soft tissues of hand leading to exposure of vital elements such as nerves, vessels, tendons, bones and joints; locoregional or distant flaps are required to cover the injured areas. The aim of the study is to introduce a new flap with better cosmetic and functional quality for the coverage of defects of the soft tissues of hand. This is a randomized clinical trial. In Hazrat Fatemeh Hospital, 20 patients with extensive soft tissue injury of hands due to various crushing trauma leading to avulsion of soft tissues were entered into this study. The subjects were divided randomly into two groups, each group consisted of 10 patients. In the case group, coverage of the defects of hands were performed with distally based radial artery perforators flaps. In the control group, other routine and known flaps such as Chinese flap (6 cases) and groin flap (4 cases) were used to cover the defects. The flap repair in the case group was nearly successful in all of the cases. Only 2 cases developed partial necrosis of the flaps, one of them managed conservatively and the other one was repaired by minor surgical procedures. After 6 months the flaps were soft and pliable. Grafts were required for the repair of all of the donor sites. In the control group 60% of the cases were operated in one stage, 20% in two stages and 20% in three stages. Total necrosis of flap occurred only in one case. After 6 months 60% of flaps were pliable and 40% were bulky requiring another additional debulking procedure in 50% of the bulky flaps. Skin grafts were required in 40% of the cases to repair the donor sites. According to this study distal radial perforators based pedicle forearm flap is a safe one-stage operation in which radial artery is preserved and offers good results in the treatment of extensive soft tissue injury of hands and can be substituted for other routine flaps.