[Application of pedicle reducing tension flap in the distally-based pedicle flap operation]

To explore the effectiveness of reducing tension method on the survival and appearance of distally-based pedicle flap.

Between October 2009 and February 2011, 27 cases of defect of extremity skin and soft tissue were repaired with distally-based pedicle flap through reducing tension flap method. There were 19 males and 8 females with an average age of 31.5 years (range, 17-58 years). Defects were caused by traffic accident in 14 cases, by machine in 9 cases, by surgical infection in 3 cases, and by tumor excision in 1 case. The locations were the distal tibia in 7 cases, the ankle-joint in 12 cases, the foot in 5 cases, the palm in 2 cases, and the dorsum of hand in 1 case. The time from injury to hospitalization was 1-19 hours with an average of 10 hours. The size of defect ranged from 5.2 cm x 3.8 cm to 14.0 cm x 5.8 cm. The size of distally-based pedicle flap ranged from 5.5 cm x 4.5 cm to 14.5 cm x 6.5 cm. The donor sites were sutured directly in 6 cases and were repaired with skin grafting in 21 cases.

All reducing tension flaps survived. Partial necrosis occurred in the distally-based pedicle flap in 3 cases at 7 days after operation, which was cured after dressing change and skin grafting in 1 case, after excision of necrosis skin edge and direct suture in 2 cases. The other flaps survived and wounds achieved primary healing. The incisions at donor sites healed by first intention and skin grafting survived. Twenty-six cases were followed up 6-12 months (mean, 7.5 months). The appearance and texture of the flaps were good.

Pedicle reducing tension flap could promote the survival and the appearance of distally-based pedicle flap.