Abstract：Objective To investigate the clinical effect of application of free upper-limb lateral chimeric bone-skin flap with sensation in the repair of finger composite tissue defect. Methods A retrospective study was performed on six patients (4 males and 2 females, aged 33–61 years, mean age 47.3 years) with finger soft-tissue defects associated with phalanx nerve defects. The patients were admitted to the Hand Surgery Department of Xuzhou Renci Hospital from November 2016 to November 2019. These patients exhibited 2 cases of right-hand and 4 cases of left-hand defects, 1 case of thumb defect, and 1 case of index finger defect. Furthermore, 1 case of middle-finger and 3 cases of ring-finger defects were observed. The skin defect area of the finger was 1.0 cm×1.5 cm–2.5 cm×3.0 cm, and the bone defect length was 1.5–2.5 cm. All the patients were treated with first-stage thorough wound debridement. The wound defect with phalangeal nerve defect was covered by heterograft skin first. The upper-arm lateral chimeric bone flap with sensation was grafted and repaired with Kirschner wire to maintain fracture stability. The designed skin flap area was 1.5 cm×2.0 cm–3.0 cm×3.5 cm, and the size of the bone flap was 1.5 cm×1.0 cm×1.0 cm–3.0 cm×1.5 cm×1.0 cm. Postoperative function was evaluated according to the hand function evaluation standard of the Chinese Society of Hand Surgery of the Chinese Medical Association. Sensory recovery was evaluated by sensory grading method developed by the British Medical Research Council. The appearance satisfaction of the affected finger was evaluated based on the Michigan Hand Function Questionnaire. Results All the 6 patients were followed up for 3–72 months, with an average of 13.5 months. All the flaps survived, the fractures healed. The average healing time of bone flaps was 3.5 (3–6) months. Primary healing of all wounds with direct suture at donor site was excellent in 5 cases and good in 1 case. Finger sensation was restored to S4 in 4 cases and S3+ in 2 cases. Appearance satisfaction evaluation of the affected finger was very satisfactory in 1 case, satisfactory in 4 cases, and general in 1 case. Conclusion The upper-arm lateral chimeric bone flap with sensation can repair finger soft-tissue defect and phalanx defect at the same time, with minimal influence on the donor site and good sensory-function recovery of the finger after operation, which is one of the options for repairing finger composite tissue defect.
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2022, Vol. 27 
