ABSTRACT
Distal thumb injuries are a common and difficult problem for hand surgeons. Coverage of soft tissue on the fingers may be difficult due to the size of the defect or the limitation of local flap mobilization. However, the variable anatomy of the dorsal hand vascular system sometimes prevents successful flap harvest. The purpose of this study was to clarify the vascular anatomy of the dorsal side of the thumb and the first web for the flaps. Twenty six hands (13 right and 13 left hands) from Korean embalmed cadavers were dissected. A catheter was inserted into the radial artery in the forearm, and the red colored latex (Latex 671, Dupont Industry, France) was injected until the dorsum of the hand was colored. The arrangement of the first dorsal metacarpal artery (FDMA) and its branches were vary and classified into three categories according to their branching patterns; Both dorso-ulnar thumb branch (DUTB) and dorso-radial index branch (DRIB) arose from the FDMA (10 cases, 38.5%). Each DUTB and DRIB arose separately from the radial artery (5 cases, 19.2%). The DUTB and the DRIB originated from the princeps pollicis artery and the radial artery, respectively (11 cases, 42.3%). The typical course of the FDMA and its branches ran overlying the first dorsal interosseous muscle in 17 cases of the 26 specimens (65.4%). However, in nine cases (34.6%) the DRIB ran on the first dorsal interosseous muscle and the DUTB had a deep course within the substance of the first dorsal interosseous muscle. The FDMA flap represents a good option to cover defects for the thumb. These anatomical findings in the present study could provide useful knowledge of flaps for dorsal aspect of the thumb and the first web.
Subject(s)
Arteries , Cadaver , Catheters , Fingers , Forearm , Hand , Latex , Muscles , Radial Artery , ThumbABSTRACT
Small to moderate-sized wounds of the hand were resurfaced in one stage by digital arterial flaps from the lateral surgace of the near by digit in 30 Cases. The flaps included only the digital arteries and small venules in their pedicles in 15 cases, preserving digital nerve intact in the donor digit.Wounds of the fingertips were repaired by transferring digital arterial flaps with a dorsal branch of the digital nerve so that the sense of the flap was preserved and the sensory loss of the donor digit was minimized in 16 cases. Excellent results were obtained in all. This technique minimizes the sensory loss of the donor digit. The lengthy pedicle allows an arc of coverage over the palm and dorsum of hand and adjacent digits. The procedure is simpler and safer than microsurgical flap transfer. The treatment period is slhoter and the outward appearance and function are better as compared with traditional tube-pedicle grafts or cross-digiti flaps.