الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Soft tissue defects in the hand are very common and result from a variety of mechanisms including trauma, infection, and malignant tumours . Our study involved male patients at age ranges from 15 to 60 years and the trauma is the major cause (70%). This was explained by the common occurrence of hand injuries in young age group (age of employment), who unfortunately, working in unsafe work environment.
Several reconstructive procedures and their modifications have evolved to provide the ideal soft tissue coverage of the hand. Conventionally, these included a range of options of primary wounds closure, skin grafts, local flaps, distant flaps, and micro-vascular free tissue transfer.
Perforator flaps represent an important source in covering tissue defects in the forearm and the hand, but also allows the realization of the imperative needs of such a procedure to replace the tissues with similar ones; to minimize donor site morbidity, especially not to sacrifice a main vascular pedicle; to shorten the evolution and the recovery period.
The propeller perforator flap have a reliable vascular pedicle and can undergo wide mobilization and rotation; their harvest does not require microsurgery; however, accurate patient selection, preoperative planning, and meticulous dissection technique are mandatory to prevent complications.
As the perforator based propeller flaps allow coverage of different defect sizes, raised with a relatively simple surgical technique , has high success rate , good cosmetic results without functional impairment. This type of flaps was selected for this purpose.
The perforators of the upper extremity are generally shorter in length as compared to those of the lower extremity. Its reported that one of the potential limitations to the wider application of the propeller flaps, especially in the distal forearm is the relatively short pedicle, which does not tend to withstand extreme (180°) rotation so well. Even though the pedicle length and diameter of the upper extremity perforators is less as compared to those of the lower extremity, so is the thickness of the skin and fascia which is transferred on the perforator. The major drawback of the perforator-based propeller flap is that the perforator must be intentionally twisted to allow the flap to rotate.
To abandon or minimize the effect of perforator twisting on propeller flap survival , some investigators advised that flap rotation must be attempted from both sides, and rotation resulting in minimal twist is selected .
In our study, the most suitable perforator was selected according to the Doppler U/S study based on its length, diameter, angle of rotation of the perforator on the radial artery and its distance from styloid radius. In addition, we used Doppler U/S post-operatively for measuring postoperative velocity and average blood flow to the flap.
We studied the effect of the perforator length and diameter on the blood flow and viability of the flap by measuring the postoperative velocity and average blood flow.
We concluded that there is a positive correlation between the perforator length, diameter and the survived area of the flap with simultaneous increased postoperative velocity and postoperative average blood flow.
So with increased perforator length and diameter, the survived area of the flap was larger with decreased duration of wound healing and the length of hospital stay.
So, with respect to the high complication rate on the flaps rotated more than 90° caused by vascular impairment, coverage of hand defects with this kind of flaps still needs further studies to eliminate the relatively high rate of complications and to focus on the influence of rotation or twist of the pedicle to the postsurgical evolution to solve the problem of venous congestion.