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Objective:To investigate the surgical technique and clinical effect of the island flap of dorsal branch of proper palmar digital artery in repair of the soft tissue defect of digits.Methods:From March 2013 to March 2021, 22 cases of digit soft tissue defects were repaired with dorsal branch of proper palmar digital artery island flap. The digit defects involved: 9 thumbs, 5 index fingers, 3 middle fingers, 3 ring fingers and 2 little fingers. The repair of defects covered 8 digit-tips, 7 pulps and 7 dorsal and nail beds. The defected area of soft tissue was 0.8 cm×0.5 cm-1.5 cm×8.0 cm, and the size of flap was 1.0 cm×0.7 cm-1.8 cm×1.0 cm. The donor site in 6 cases was closed directly. The other 16 cases were covered with medium thickness skin graft and pressurised bandaging. The follow-up reviews were carried out via the outpatient clinic visit, telephone or WeChat interview. Results:After operation, 1 flap had cyanosis due to a tight suture and it was relieved after the removal of intermittent suture; Tension blisters appeared in 2 cases and disappeared after 1 week; One case had necrosis at distal flap and healed after dressing change. Other flaps survived successfully and the incision and donor site healed in the first stage. All patients were entered to 6 to 18(mean 10) months of follow-up. At the final follow-up, the appearance and texture of the flaps were good and the protective sensation was restored. The flexion and extension function of the affected digit was normal with the TPD at 7-11 mm. The original shape and function of the digit body were basically reconstructed, except the failure in reconstruction of the special structure of digit body, such as nail, finger pulp thread and fine sensation. According to the Evaluation Standard of Upper Limb Function of Chinese Hand Surgery Society, 11 cases were in excellent, 9 in good and 2 in fair. The excellent and good rate was 91%. The function at donor sites was not affected.Conclusion:Repair of digit soft tissue defect with dorsal branch of proper palmar digital artery island flap is easy to operate, and with a low risk, high success rate and satisfactory curative effect.
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Objective:To describe the reconstruction of palmar soft tissue defect of digit using dorsal digital flaps including double dorsal branches of the proper palmar digital nerves (DBPPDN) and report the results of the application of the flaps.Methods:From May, 2005 to April, 2019, a retrospective study was conducted on 113 digits of 113 patients who had palmar soft tissue defects in single digit treated with 4 types of dorsal digital flaps with bilaterally DBPPDN. Flap types: ① Modified cross-digit flap in 29 digits of 29 cases; ②Dorsal digital flap based on the dorsal branch of proper palmar digital artery (DBPPDA) in 43 digits of 43 cases; ③First dorsal metacarpal artery flap in 23 digits of 23 cases; ④ Free dorsal digit flap in 18 digits of 18 cases. In control group, single-innervated flap was used for repair of the defects, only one of injured proper palmar digital nerves on both sides was repaired with DBPPDN. Static TPD, VAS and patient satisfaction of the injured digits were evaluated by means of outpatient follow-up. The t test was applied to compare the 2 groups in relation to the quantitative outcomes. P<0.05 was considered statistically significant. Results:In the dual-innervated flap group, flap ischemia was shown in 11 digits and venous congestion was noted in 7 digits. Partial necrosis was noted in 9 flaps and healed without surgical intervention. In the dual-innervated and single-innervated flap groups, the mean static TPD were (6.92±0.12) mm and (8.92±0.20) mm, the score of VAS were (0.46±0.08) and (1.11±0.28), and patient satisfaction were (4.45±0.06) and (4.00±0.16). Significant difference was found between the 2 groups in static TPD, VAS and patient satisfaction. Dual-innervated flaps presented better discriminatory sensation on the flap ( P<0.01) and lower pain incidence ( P=0.0032) and higher patient satisfaction ( P=0.0014). Conclusion:The 4 types of dual-innervated flap are useful in reconstruction of palmar soft tissue defects of digits, especially in prevention of neuropathic pain.
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Background: Knowledge regarding the course and termination of the radial artery before harvesting it for coronaryartery bypass graft surgery (CABGS) is important. The brachial artery terminates at the neck of radius into radialand ulnar arteries.Purpose of the study: To know the various patterns of anomalous division ofthe radial artery.Methods: The study included 50 upper limb specimens from the Department of Anatomy, Sree Narayana Instituteof Medical Sciences, Ernakulam. The specimens were fixed with 10% formalin solution and the radial artery wasexposed from its origin till termination and observations were noted down.Results: The present study revealed that, radial artery usually was arising from brachial artery at the level ofneck of radius. The variants observed included high bifurcation of brachial artery, division of radial artery intopalmar and dorsal branches in the forearm and anomalous course of radial artery in the region of anatomicalsnuff box.Conclusion: The present study has revealed the anomalous division and course of radial artery around the wristand anatomical snuff box and the knowledge of such anomalous course is important for diagnostic, interventionaland surgical procedures.
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Objective To compare the clinical effect and operation difficulty of the combined skin flap with reversed proper palmar digital arterial dorsal branch island flap and cross-finger flap and the abdominal flap in the treatment of distal finger degloving injury.Methods Inclusion criteria:①Soft tissue defect far beyond the level of distal interphalangeal joints.②The inured finger was from second to fifth.③Single finger injury.④ Iniury time within 8 h.Exclusive criteria:①With tendon injury.② Multiple finger injuries.③Followed-up time within 6 months.Between February,2009 and September,2016,52 patients (52 fingers) with distal finger degloving injury were reviewed,there were 32 males and 20 females,aged from 18 to 60 (36.02±11.00) years.The time from injury to operation was 2.5-8.0 (4.81±1.28) h.Affected fingers included index finger in 15 cases,middle finger in 22 cases,ring finger in 10 cases,and little finger in 5 cases.Twenty patients (20 fingers) were treated by combined skin flap with reversed digital arterial dorsal branch island flap and cross-finger flap(group combined-flap).The cubital skin was grafted onto the donor sites.Thirty-two patients (32 fingers) were treated by abdominal flap (group abdominal-flap).Results The patients were followed-up 6-25 (9.25±3.97) months.The operation time:group combined-flap was 80-130 (98.46±8.34) min and group abdominal-flap was 85-125(107.84±8.63)min.There was no significant difference in two groups (P＞0.05).Pedicle division time:group combined-flap was 15-24 (16.75±1.74) d and group abdominal-flap was 24-45 (28.31±5.12) d.There was a significant difference in two groups (P＜0.05).And the pedicle division time in group combined-flap was much shorter than in group abdominal-flap.Flap function at last follow-up,the excellent and good rate of the flap in group combined-flap and group abdominal-flap was 90.00％ and 59.38％,respectively.There was a significant difference in two groups (P＜0.05),and the flap function in group combined-flap was much better than in group abdominal-flap.Affected finger function at last follow-up,the excellent and good rate of the affected fingers was 95.00％ and 71.88％.There was a significant difference in two groups (P＜0.05),and the affected finger function in group combined-flap was much better than in group abdominal-flap.Conclusion The combined skin flap with reversed digital arterial dorsal branch island flap and cross-finger flap is a simple and high-survival-rate flap,whose texture,appearance and clinical outcome for repair of distal finger degloving injury are much better than traditional abdominal flap.
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Objective: To investigate the effectiveness of ipsilateral digital proper artery dorsal branch flap to repair mid-phalanx degloving injury with distal segment finger defect. Methods: Between February 2013 and July 2016, 11 cases (11 fingers) of mid-phalanx degloving injury with distal segment finger defect were treated. There were 9 males and 2 females with an average age of 33.6 years (range, 18-59 years). The injury caused by twisting in 8 cases and crushing in 3 cases. The injury located at index finger in 3 cases, middle finger in 6 cases, and ring finger in 2 cases. The skin avulsion was from proximal interphalangeal joint in 1 case, proximal 1/4 of mid-phalanx in 6 cases, and 1/2 of mid-phalanx in 4 cases. The area of wounds ranged from 4.0 cm×1.7 cm to 6.2 cm×2.6 cm. The interval between injury and operation was 2.5-6.0 hours (mean, 4.5 hours). All defects were repaired with the ipsilateral digital proper artery dorsal branch flaps. The size of flaps ranged from 4.4 cm×1.9 cm to 7.0 cm×2.9 cm. Nerve anastomose was carried between digital proper nerve dorsal branch in the flap and digital proper nerve stump in the wound. The donor sites were repaired by skin grafting. Results: Tension blisters of the flap and partial necrosis occurred in 1 case, and healed after dressing change. The other flaps and skin grafting survived, and wounds healed by first intention. All patients were followed up 6-18 months (mean, 16 months). The texture and appearance of all the flaps were satisfactory. At 6 months after operation, two-point discrimination of flaps ranged from 7 to 10 mm (mean, 8.5 mm). At last follow-up, according to the functional assessment criteria of upper limbs by the Branch of Hand Surgery of Chinese Medicine Association, the results were excellent in 10 cases and good in 1 case, with the excellent and good rate of 100%. Conclusion: The ipsilateral digital proper artery dorsal branch flap is a good method to repair mid-phalanx degloving injury with distal segment finger defect for the advantages of simple operation, less damage in donor site, high survival rate of the flap, and good feeling recovery of the finger.
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Objective To discuss the clinical application of free micro-flap based on the superficial palmar branch of radial artery (SPBRA) to repair the palmar soft tissue defect of the finger.Methods From October,2012 to September,2015,this flap was used in 25 patients to repair the palmar soft tissue defect of the finger.The artery,the vein and the never in the flaps was anastomosed respectively with that in the recipient site.The donor area was sutured directly.Results All patients were followed-up for a mean of 11 months (range,6-20 months).All 25 flaps survived.The character of flap was good,the appearance and sensitive function obtained satisfactory resume.At the last follow-up,the two-point discrimination was 5-10mm on the affected side.According to the Standard of Evaluation of Thumb-Finger Reconstruction of the Chinese Medical Association,there were excellent in 17 cases,and good in 8 cases.The wounds of donor site healed by 1st intention with no visible scars.The function of thumb was not damaged.Conclusion The free micro-flap based on the SPBRA is feasible for soft-tissue defects of finger bacause the undamaged major blood vessels of donor site,the inconspicuous scar,and the good appearance and sensitive function of repaired fingers.
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Objective To investigate the clinical curative effect of the surgical method of transferring the radialis proper digital nerve of damaged index finger and its dorsal branch to repair the thumb nerve evulsion.Methods 13 patients with thumb nerve evulsion were treated.There were 8 males and 5 females with an average age of 28 years (ranged 18-52 years old).The injuries were caused by machine twist (8 cases),gear(4 cases),electric saw (1 case).And thumb rotational avulsion amputation (10 cases),thumb incompleteness amputation(3 cases).The time from injury to admission was 1-3.5 h (mean 2.2 h).The average time from injury to admission was (1.1 ± 1.5) h.The amputate level of skin was at the juxtra-articular of metacarpophalangeal joint.The amputate level of bone was at the base of proximal phalanx (6 patients) and metacarpophalangeal joint (4 patients),interphalangeal joint(3 patients).Using transferring the radialis proper digital nerve of index finger without reimplantation and its dorsal branch to.repair the both side injuries of thumb nerve evulsion.According to routine method to repair digital bone,veins,arteries and tendons.Results All 13 chases were followed up for 6 months to 2 years and 7 months postoperatively,with an average of 22 months.The wounds and incisions at donor sites were healed by first intention.All 13 cases of thumb reimplantation were successful.Two-point discrimination of ulnaris finger pulp was 2 to 6mm,average 4.2mm,and the radialis was 5 to 9mm,average 7.8mm.Sensory function was rated as S4(the ulnaris in 12 cases and the radialis in 2 cases) and S3 + (the radialis in 11 cases and the ulnaris in 1 cases).Conclusion Transferring the radialis proper digital nerve of damaged index finger and its dorsal branch to the digital nerve on the neighboring thumb is a simple and effective method to restore sensory function of the pulp.
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Objective To Summarize the application of digital artery dorsal distal interphalangeal joint perforator flap to repair finger tip skin defect,and at the same time,the method and effect of anastomosis of finger dorsal branch of digital nerve sensory reconstruction.Methods From September 2012 to March 2015,78 patients 92 fingers were treated in Orthopedics Department of Jinshan Branch Hospital of the Sixth People′s Hospital of Shanghai,all patients with finger artery distal interphalangeal joint dorsal cutaneous branches of the dorsal flap pedicled with retrograde,transferred to repair the skin defect of finger end,and anastomosis of dorsal branch of the proper digital nerve reconstruction.Results Postoperative vascular crisis occurred in 8 cases,2 cases of partial flap necrosis and healed after symptomatic treatment.All flaps survived,the wounds healed in I stage,and the donor site healed in I stage.All the 73 cases were followed up,the follow-up period ranged from 3.0 to 12.0 months,an average of (7.8±2.5) months.The postoperative appearance and feel good,soft texture,abrasion resistance,no tenderness,cold resistance,dynamic two-point recovered to 4.0-8.0 mm,average (5.3±0.9) mm.Static two-point discrimination was 4.0-9.0 mm,average (5.8±1.2) mm.The method of TAM was used to determine the function of the 67 fingers,good for the 7 finger,but also for the 5 finger and the difference of the 0 finger.The excellent and good rate was up to 93.7%.Conclusion The operation without sacrifice of major arteries and nerves by finger,the middle finger dorsal skin for non functional surface area,and at the same time by anastomosis of dorsal branch of the proper digital nerve reconstruction,without surgery two times,is one of the ideal surgical repair of skin defect of the finger end.
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Objective To explore the clinical effect of dorsal digital artery reverse island flap in the repair of distal finger skin defect.Methods From January,2011 to January,2015,60 fingers of 60 cases with dorsal branch of the digital artery were used to repair the defect of the distal finger skin.The 30 refers to the index finger,middle finger 15 fingers,10 ring fingers and 5 little fingers.Harvested area of 1.2 cm ×1.7 cm to 3.2 cm × 3.6 cm,the wrist or distal medial arm full thickness skin graft donor site.Evaluation of sensory recovery by the British Medical Research Association.Results All flaps survived.Twelve finger flap tension blisters,and the flaps survived after the stitches.Follow-up of 60 cases of 60 to hand function according to the Chinese medicine will hand surgery society of upper extremity function evaluation standard trial Tam method to evaluate the:50 excellent,10 fingers good,the excellent and good rate was 100％;48 fingers flap sensation recovery to S4 class,and 12 refers to the recovery to S3.The two-point discrimination perception of 5 to 8 mm,average 6.5 mm;patients far,nearly interphalangeal joint average activity recovery was good.Skin flap skin ruddy,soft texture,no fat,no pigmentation,fearless cold performance.No scar hypertrophy and contracture,skin pain no allergy and reoperation.Conclusion The flap for repair of distal finger skin defect is a simple,no damage to the main artery and nerve and good sensory recovery,less postoperative complications,and excellent method of flap survival.It is worth promotion in primary hospitals.
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La inervación sensitiva del dorso de la mano está dada principalmente por ramos provenientes del ramo superficial del nervio radial (RSNR) y del ramo dorsal del nervio ulnar (RDNU). La distribución del primero, abarcaría la zona desde el pulgar a la mitad radial del dedo anular y el segundo, la mitad ulnar de este dedo así como el dedo mínimo. El presente estudio tuvo por finalidad describir el origen, trayecto, distribución y ramificación del ramo dorsal del nervio ulnar. El estudio mediante disección fue realizado en 30 miembros superiores de individuos adultos, Brasileños y 6 miembros superiores de individuos adultos, Chilenos, fijados en formaldehido al 10 por ciento, de los cuales 16 eran miembros del lado derecho y 20 del lado izquierdo. Los primeros estaban localizados en la Universidade Estadual de Ciencias da Saúde de Alagoas, Maceió, Brasil y los segundos en la Facultad de Medicina de la Universidad de la Frontera, Temuco, Chile. El RDNU se originó a nivel del tercio distal del antebrazo proximal al proceso estiloides ulnar en 34 miembros (94,4 por ciento). En todas las muestras la distribución del RDNU en el dorso de la mano se comporta de forma similar con la diferencia de tener o no un ramo comunicante con ramos del RSNR. De acuerdo a esto clasificamos su disposición en un grupo con ramo comunicante y en otro sin ramo comunicante. Se observó 21 muestras (58,3%) con ramo comunicante y 13 sin el mismo. El comportamiento de las divisiones del ramo dorsal del nervio ulnar es descrito y padronizado. En los 21 casos el RDNU proporcionó 5 nervios digitales, correspondientes al dedo mínimo, anular y el de la parte ulnar del dedo medio. Sin embargo, en estos casos el RDNU recibió colaboración de fibras provenientes de RSNR. En 13 casos (36,1 por ciento) el RDNU proporcionó 5 nervios digitales dorsales, correspondientes al dedo mínimo, anular y la parte ulnar del dedo medio, sin colaboración del RSNR. En 2 casos (5,6 por ciento)...
The sensory innervation of the dorsum of the hand is mainly given by branches from the superficial branch of the radial nerve (SBRN) and the dorsal branch of the ulnar nerve (DBUN). The distribution of the first, cover the area from the thumb to the radial half of the ring finger and the second, the ulnar half of this finger and the little finger. This study aimed to describe the origin, course, distribution and branches of DBUN. The study by dissection was performed in 30 upper limbs of adult Brazilian individuals and 6 upper limbs of adult Chilean individuals, fixed in 10% formaldehyde, 16 of which were members of the right side and 20 on the left. The first individuals were located in the Universidade Estadual de Ciencias da Saude, Alagoas, Brazil and the second, in the Faculty of Medicine, Universidad de La Frontera, Chile. The DBUN originated at the distal third of the forearm proximal to the ulnar styloid process in 34 limbs (94.4 percent).In all samples the DBUN distribution in the dorsum of the hand behaves similarly with the difference of having or not a communicating branch with the SBRN. Accordingly we classify in a group with communicating branch and another without communicating branch. 21 samples (58.3 percent) with communicating branch and 13 (36.1 percent) without it were observed. The division patterns of the dorsal branch of the ulnar nerve is described. In 21 cases the DBUN gave 5 digital nerves corresponding to the little finger, ring finger and the ulnar side of the middle finger. However, in these cases the DBUN received fibers from SBRN. In 13 cases (36.1 percent) the DBUN gave 5 dorsal digital nerves, corresponding to the minimum finger, ring finger and the ulnar side of the middle finger, without collaboration of the SBRN. In 2 cases (5.6 percent) the dorsal digital nerves were provided only by the SBRN without DBUN contributions. In relation to the presence of communication between DBUN and SBRN...
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Humans , Adult , Hand/innervation , Ulnar Nerve/anatomy & histologyABSTRACT
Objective To provide anatomical landmarks with which to facilitate flap dissection,we studied the perforator artery of the dorsal forearm including its source,quantity,origination,caliber,variation and pedicle length. Methods Ten fresh cadavers were injected with a modified lead oxide-gelatin mixture,and three-dimensional graphics of the perforator vessels of the dorsal forearm were reconstructed with a computed tomography. In addition, twenty upper extremity specimens were injected with red latex via the axillary artery.The integument of the forearm was dissected,and perforators were identified,including type,course,size and location were documented.Surface areas were measured with Scion Image. Results The average number of the posterior interosseous artery cutaneous perforators in the dorsal forearm was (5±2),the average outer diameter of the perforator artories was (0.5 ± 0.1) mm,and the pedicle length was (2.5 ±0.2) cm.The average cutaneous vascular territory was (22.0 ± 15.0) cm2.The dorsal branch of the anterior interosseous artery dispersed on the wrist dorsum or the distal third of the dorsal forearm. It's average diameter was 0.8 mum. Conclusion The free transplantation of the posterior interosseous perforator artery flaps or rotary flap pedicled by the dorsal branch of the anterior interosseous artery for defect reconstruction are feasible.