THE USE OF GROIN FLAP FOR HAND DEFECTS: WHICH SHOULD BE PRIOR, FREE OR PEDICLED, BASED ON PATIENT-REPORTED OUTCOMES?

ABSTRACT

Introduction: Most of the large defects in the hand are required vascularized skin coverage because they exposed tendons and bones. A pedicled groin flap has been offered as a standard flap for this indication. But immobilization of the upper extremity can be a disadvantage. Raising the groin flap is also possible as a free flap. The disadvantage of free flap is a time-consuming microsurgical procedure. We aimed to compare the pedicled and free groin flap reconstructions in patients with large hand defects based on patient-reported outcomes.

Materials and Methods: Sixteen patients who had groin flaps pedicled or free for the large defects of their hands were included in this study between 2013-2020. This study was performed retrospectively clinical survey work. Patients were divided into two groups: the pedicled groin flap group (n=8) and the free groin flap group (n=8). Patients were followed for 2 years. The patients were subjected to DASH and SF-36 tests after a postoperative period. Pre- and postoperative pain were evaluated with the Visual Analogue Scale. On which day they could walk and sit in the toilet without pain and not needed a second person for daily work, the patients were asked.

Results: Half of the patients with pedicled flaps had serious elbow and shoulder pain and required physical therapy. The wound healing was completed significantly earlier in the free groin flap group (p<0.05). The mean hospital stay in the pedicled group was longer than the free flap group (21 days and 13 days, respectively), which was statistically insignificant. The DASH scores were found to be 92 and 72 in the subacute and chronic stages in the pedicled flap group, whereas 52 and 24 were found in the free flap group, respectively (p = 0.012 and 0.002). According to SF-36 scores, physical functions were impaired significantly in the pedicled flap group (p < 0.001). The number of days needed by the second person for daily work was 79 in the pedicled group and 24 in the free flap group (p = 0.041). Sitting in the toilet without pain was started on the 63rd day in the pedicled group and on the 15th day in the free flap group (p = 0.036).

Conclusions: By transferring the groin flap as a free flap, the problems related to shoulder and elbow joints have disappeared, hand rehabilitation could be started earlier, and the time to return to daily work was shortened. So, if the groin flap is preferred, free style should be considered first.