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Objective:To investigate the method and outcome of reconstruction of thumb soft tissue defect by index finger proximal dorsal island flap supplied by the second dorsal metacarpal artery (SDMA).Methods:From August, 2015 to December, 2017, 12 cases of thumb soft tissue defect were treated by index finger proximal dorsal island flap supplied by SDMA. The site of defect ranged from 2.0 cm×2.4 cm to 5.5 cm×3.0 cm, and the flap area ranged from 2.2 cm×2.6 cm to 6.0 cm×3.3 cm. The donor site was repaired by split-thickness skin graft from the forearm of the injured limb. All patients received regular outpatient follow-up after surgery. The appearance, texture, sensory recovery and donor site of the flap were observed.Results:All the 12 flaps had 5-16 (8.8 in average) months follow-up and survived, the donor site and wounds healed in primary stage. The appearance, sensory and function of the flaps were good. There were no scar contracture on the donor sites, and no pain and limitation of motion in the joints. At the last follow-up, according to the Criteria for Function Assessment of Upper Limbs by the Branch of Hand Surgery of Chinese Medicine Association, the thumb functions were excellent in 11 cases and good in 1 case.Conclusion:Index finger proximal dorsal island flap supplied by SDMA is easy to operate, and has constant blood supply, improved rotation angle of the flap vessel base. It is a good method to repair the soft tissue defect of thumb.
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Background: Reconstruction of soft tissue defects of the thumb, with exposure of tendon, joint or bone, has been a challenging problem. Surgical options include local, regional or free flaps. Here, we have evaluated the functional and aesthetic outcomes of first dorsal metacarpal artery (FDMA) island flap in reconstruction of various soft tissue defects of the thumb.Methods: Between January 2018 and January 2019, twenty patients with post-traumatic and post-infective thumb defects underwent FDMA flaps. Sensory function was evaluated with static 2 point discrimination and mobility of the thumb was tested by the Kapandji score. The aesthetic outcome was also assessed.Results: The mean defect size was 39.9×19.95 mm. Eighteen flaps survived completely and one had distal flap necrosis and one had superficial epidermal peeling which was treated conservatively. The mean static two-point discrimination was 9.3 mm. Cortical reorientation was complete in 45%. The average Kapandji score was 7.9. The aesthetic outcome was excellent in ten, good in eight and poor in two subjects. After a mean follow up period of 11.85 months, most patients regained all functions of the thumb and index finger and were pleased with the cosmetic appearance of the flap and donor site.Conclusions: FDMA flap offers a good quality skin cover for small to moderate sized thumb defects. It is a reliable and versatile flap which is sensate and pliable. It gives excellent functional and aesthetic outcomes with minimal or no donor site morbidity.
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Objective@#To observe the location and the distribution of distal 1/3 segment of the second dorsal metacarpal artery, the finger web artery and the dorsal digital artery, and to provide anatomical data for repairing the soft tissue defect on the hand with bilobed or multi-lobed micro-flap with second metacarpal dorsal artery-dorsal digital artery.@*Methods@#From June, 2018 to March, 2019, 34 fresh adult upper limb specimens were selected. The radial and ulnar arteries were perfused with red latex in 24 specimens. The radial and ulnar arteries were infused with cast materials to make cast specimens in 10 specimens. The location and distribution of the distal 1/3 segment of the second dorsal metacarpal artery, the finger web and the dorsal digital artery were observed.@*Results@#The distal 1/3 segment of second dorsal metacarpal artery extended (4±1) cutaneous branches, and continued to become the finger web artery at the plane of the articular surface. The length of the finger web artery was (2.5±0.6) cm, and there were 4 types anastomic methods of communication with arteries. The second dorsal metacarpal artery extended 2 finger dorsal artery to the proximal dorsal skin of the middle finger and index finger. The length of dorsal digital artery was 2.6±0.4 cm and the diameter was 0.2±0.1 mm. Four to 6 micro-cutaneous branches were extended and consistent with the nearby skin cutaneous branches.@*Conclusion@#The distal segment of the second dorsal metacarpal artery and the dorsal digital artery is anatomically constant. The distal segment of the second dorsal metacarpal artery and dorsal digital artery are the pedicle for the design of the bilobed flap of middle finger and index finger to repair small soft tissue defect on the thumb and purlicue.
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Objective To observe the location and the distribution of distal 1/3 segment of the second dorsal metacarpal artery, the finger web artery and the dorsal digital artery, and to provide anatomical data for repairing the soft tissue defect on the hand with bilobed or multi-lobed micro-flap with second metacarpal dorsal artery-dorsal dig鄄ital artery. Methods From June, 2018 to March, 2019, 34 fresh adult upper limb specimens were selected.The ra鄄dial and ulnar arteries were perfused with red latex in 24 specimens. The radial and ulnar arteries were infused with cast materials to make cast specimens in 10 specimens. The location and distribution of the distal 1/3 segment of the second dorsal metacarpal artery, the finger web and the dorsal digital artery were observed. Results The distal 1/3 seg鄄ment of second dorsal metacarpal artery extended (4±1) cutaneous branches, and continued to become the finger web artery at the plane of the articular surface.The length of the finger web artery was (2.5±0.6) cm, and there were 4 types anastomic methods of communication with arteries.The second dorsal metacarpal artery extended 2 finger dorsal artery to the proximal dorsal skin of the middle finger and index finger. The length of dorsal digital artery was 2.6 ±0.4 cm and the diameter was 0.2±0.1 mm.Four to 6 micro-cutaneous branches were extended and consistent with the nearby skin cutaneous branches. Conclusion The distal segment of the second dorsal metacarpal artery and the dorsal digital artery is anatomically constant. The distal segment of the second dorsal metacarpal artery and dorsal digital artery are the pedicle for the design of the bilobed flap of middle finger and index finger to repair small soft tissue de鄄fect on the thumb and purlicue.
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Objective To investigate the surgical methods and clinical effect of repairing the thumb tip defects in infants by applying the reversed first dorsal metacarpal radial artery island flaps along with anatomosing of nerves and veins.Methods Twenty-one cases with soft tissue defects of thumb tips caused by trauma were admitted from August,2015 to August,2017.The first dorsal metacarpal radial island artery flaps were transplanted reversely to repair the defects along with the anatomosis of nerves and veins.Among all the cases,the range of defect area was 2.0 cm×1.8 cm-3.0 cm×2.5 cm.The area range of the flap harvested during the surgery was 2.2 cm×2.0 cm-3.2 cm×2.7 cm.The regular post-operative followed-up was performed.Results All flaps survival after the surgeries,and the wounds were I-staged healing.All cases were followed-up by 3-18 months,and the average time was 7 months.The appearance and quality of the flaps were good.The range of motion of the metacarpophalangeal joints and interphalangeal joints was normal.According to the Upper Extremity Functional Evaluation Tentative Criteria set up by Hand Surgery Branch of Chinese Medical Association,14 cases were excellent,5 case was good,and 2 cases were fair.Conclusion The surgery of using the first dorsal metacarpal radial reversed island artery flap to repair the defect of thumb tip in infant,along with the anatomosis of nerve and vein,is a good method in repairing the defects due to its ease of operation,achievement of plump of finger tip and good recovery of appearance and sensation after the surgery.
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Objective To observe the treatment outcome of using reversed island flap based on cutaneous branch of dorsal metacarpal artery for middle-and-distal finger soft tissue defect.Methods From May,2015 to March,2017,21 cases of middle-and-distal finger soft tissue defect were treated with reversed island flaps based on cutaneous branch of dorsal metacarpal artery which were designed on the dorsal hand pedicled by dorsal metacarpal artery.The flap was then elevated and rotated at the point where digital common artery was anastomosed with the terminal branch of the dorsal metacarpal artery.The cutaneous nerve included in the flap was anastomosed with the terminal branch of digital nerve to restore sensation and the donor site was covered directly.Regular followed-up was performed after operation.Results Except 1 case was suffered with distal 1/3 skin flap necrosis,flaps were well developed.Postoperative follow-up period was 3 to 12 months.All these flaps recovered with satisfying appearance and quality,excellent sensation with grade S3 to S4 and 5 to 8 mm of two-point discrimination.Range of motion(ROM)of the metacarpalphangeal and interphalangeal joint of the injured fingers was good.The excellent and good rate was 95.2％.Conclusion Reversed island flap based on dorsal cutaneous branch of dorsal metacarpal artery transfer is an ideal method for repairing middle-and-distal finger soft tissue defect.The surgery is simple.Reliable blood supply and sensation can be achieved without sacrificing the primary artery and nerve.There is minor donor site damage and very few complications.
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Objective To observe the effect of two reverse pedicle flap repaired soft tissue defect of the finger.Methods From April,2011 to March,2015,46 patients were randomly divided into two groups.Twenty-eight cases were performed by dorsal metacarpal artery flaps with cutaneous branches as pedicle and the 18 cases were performed by reverse the proper palmar digital artery dorsal branches island flap.The complication,survival rate,hand function and appearance were analyzed.Results The dorsal metacarpal artery flaps with cutaneous branches as pedicle and reverse the proper palmar digital artery dorsal branches island flap were an average follow-up of 18 and 15 months,all flaps survived.For fingertip defects,8 cases were repaired with as pedicle as the dorsal metacarpal artery flaps with cutaneous branches as pedicle while 16 cases were repaired with reverse the proper palmar digital artery dorsal branches island flap.Among them,complication included 2 cases of early venous congestion and 2 cases of superficial skin necrosis.One case of reverse the digital artery dorsal branches island flap blistered;the flap sensibility was good recovery.The two-point discrimination testing of dorsal metacarpal artery flaps with cutaneous branches as pedicle was from 6.0 to 9.0 mm (average of 7.1 ± 0.5 mm);the two-point discrimination testing of dorsal metacarpal artery flaps with cutaneous branches as pedicle was from 4.0 to 7.0 mm (average of 5.2 ± 0.4 mm),but there were differences in two-point discrimination and there was statistically significant (P ＜ 0.05).There was no significant difference between the two groups each finger interphalangeal joint activity compared with the healthy side.The study found that 10 cases of dorsal metacarpal artery flaps appearance was 5 mm higher than normal skin and 1 patient of reverse the digital artery dorsal branches island flap appearance was 5 mm higher than normal skin,the difference was statistically significant (P ＜ 0.05),the latter was better than the former,especially repaired fingertip defect.Conclusion Dorsal metacarpal artery flaps with cutaneous branches as pedicle and reverse the proper palmar digital artery dorsal branches island flap were safe and reliable,it is the ideal flap finger defects.For finger fingertip defect repaired reverse the proper palmar digital artery dorsal branches island flap is superior dorsal metacarpal artery flaps with cutaneous branches as pedicle.
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Objective To discuss the coverage of finger soft tissue defect with dorsal proximal digit fasciocutaneous flap on the middle and distal digit.Methods From May,2013 to December,2014,8 cases with soft tissue defects at 8 fingers were treated with dorsal proximal digit fasciocutaneous flap.The flap sizes ranged from 2.5 cm × 2.0 cm to 3.5 cm × 3.0 cm.The donor site were closed straightly.Results Eight flaps of 8 fingers survived.All the wounds at the donor sites healed well.Eight fingers in 8 cases were followed up for 6-12 months.The color,texture and contour of the flaps were satisfied.The two-point discrimination distances were 8-10 mm.Conclusion The skin defect in the middle and distal digit can be satisfied covered with dorsal proximal digit fasciocutaneous flap.This flap is a simple,reliable and safe management for digit defect and can be performed in the primary hospital.To ensure the surviving of the flap,ensure the surviving of the flap,the awareness of the anatomy of the flap should be known well.The limits of its reconstruction of sensation and coverage size exit in its application.
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Rheumatoid arthritis is a long lasting autoimmune disorder that primarily affects joints, and patients with rheumatoid arthritis are predisposed to development of chronic skin ulcers. In addition, skin ulcers with rheumatoid arthritis tend to persist despite treatment because of sustained inflammation and poor healing capacity. Treatment of skin ulcers involves medications, wound coating agents, and surgical procedures including skin grafting, however, wound dressing or skin grafts are generally excluded because of excessive cost and time and poor intake rate. The dorsal metacarpal artery perforator (DMAP) flap, a vascular island flap for coverage of soft tissue defects on the fingers, provides promising results including matched quality and color. We experienced a case of DMAP flap for reconstruction of a rheumatoid ulcer, and a DMAP flap may be considered as a good faithful option for treatment of patients with rheumatoid ulcer.
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Humans , Arteries , Arthritis, Rheumatoid , Bandages , Fingers , Inflammation , Joints , Perforator Flap , Skin , Skin Transplantation , Skin Ulcer , Transplants , Ulcer , Wounds and InjuriesABSTRACT
Objective To investigate the method and result of repairing multi-fingers soft tissue defects using the dorsal metacarpal flaps with cutaneous branches as pedicle.Methods From February,2010 to January,2013,9 patients with multi-fingers tissue defects were treated with the 2nd,3rd,4th dorsal metacarpal flaps with cutaneous branches as pedicles.The area of flaps ranged from 1.2 cm × 2.5 cm to 2.5 cm × 5.0 cm.The donor sites were sutured with full thick skin graft.Results All flaps survived.After a followed-up of 8 months to 24 months(average 12 months),the texture and shape of the flaps were good and non-bloated.The flap sensibility as sessment were S3-S3+.The two-point discrimination testing were 10 to 13 mm (average 11.6 mm).The TAM score of range of motion was 60％ to 75％ of the healthy side.The skin graft of donor site were soft.Conclusion Procedure of dorsal metacarpal flaps with cutaneous branches as pedicles easy is a good method to repaire the soft tissue defects of muhi-fingers.
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ObjectiveTo evaluate the clinical efficacy of cutaneous branches of reverse second and third dorsal metacarpal artery fasciocutaneous flaps for repair of distal- and middle-segment finger soft tissue defects. MethodsA total of 14 patients with distal- and middle-segment finger soft tissue defects complicated by exposure of the phalanx or tendon were repaired by using cutaneous branches of second and third dorsal metacarpal artery fasciocutaneous flaps ranging between 2.0 cm × 4.5 cm and 3.0 cm × 7.0 cm.ResuitsAll of the skin flaps survived after surgery.Follow-up data during a 6-40 month period showed that the flaps exhibited a satisfactory appearance.They were not fat or clumsy,with a 2-point discrimination of 59 mm,and there was good recovery of finger function.The donor site was able to be directly sutured without dermoplasty.Pigmented linear surgical streaks appeared in the donor site.Conclusion The cutaneous branches of Second and third dorsal metacarpal artery fasciocutaneous flaps provide a good approach for the repair of distal- and middle-segment finger soft tissue defects and functional reconstruction because of convenient dissection,little trauma,sufficient use of the dorsal metacarpal artery.
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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.
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Arteries , Cadaver , Catheters , Fingers , Forearm , Hand , Latex , Muscles , Radial Artery , ThumbABSTRACT
PURPOSE: The aim of this study was to report the efficacy of the first dorsal metacarpal artery island flap for soft tissue defect of the thumb. MATERIAL AND METHODS: We performed the first dorsal metacarpal artery island flap for soft tissue defect of the thumb in 14 cases since 1992 to 2008. There were dorsal defect in 9 cases, volar defect in 2 cases and lateral defect in 3 cases. The cases are limited by defect size under 2.5 cm in width. We checked a vessel diameter in the flap pedicle, a mobile pedicle length in operative field. Evaluation results was based on flap quality, donor site quality, two-point sensory discrimination, scar contractures, total active movement of the thumb and donor digit. RESULTS: The flap quality was well vascularized and survived in 12 cases (success rate : 86%). Diameter of vessels in flap was estimated within 0.5 mm by operational findings. Dorsal vein was irregular and complicated. Average of the pedicle length was 3.2 cm. Sensory function were preserved in all cases after long term follow up, but the cases we could measure two-point discrimination were 9 cases and average was 5.3 mm. Donor sites were dermatized using skin graft and 2 cases were complained limitation of motion at joints of index finger. CONCLUSION: The failure rate of flap were about 14%. We considered that it need to prepare under operational microscopy because vessels distributed into flap are small and complex. Problems of donor site are not negligible. However it was regarded as a useful island flap which could preserve sensory function in case of soft tissue defect of thumb when it applied to appropriate cases and operated by skilled procedure.
Subject(s)
Humans , Arteries , Cicatrix , Contracture , Discrimination, Psychological , Fingers , Follow-Up Studies , Glycosaminoglycans , Joints , Microscopy , Sensation , Skin , Thumb , Tissue Donors , Transplants , VeinsABSTRACT
Objective To explore the surgical technique of applying the third retrograde 3rd dorsal metacarpal artery island flap with d orsal metacarpal superficial vein i n order to expand the repairing range of the3rd dorsal metacarpal artery island flap and increase the survival of the flap.Methods After 1999,13cases of the dorsal and pulp soft tissue defect of the 3rd and 4th fingers were designed to be repaired with the third dorsal metacarpal artery island fla p with dorsal metacarpal superficia l vein.The flap pedicle carried the 3rd dorsal cutaneous nerve and superficial metacarpal vein.The flap axis extended proximally 6cm along the original axis.The flap was harvested according to t he axis of the superficial vein.Results All flaps survived completely and2cases seemed survived as vein flaps.Consclusions This surgical technique can be used t o expand the re-pairing range of the 3rd dorsal metac arpal artery island flap,and be suitable to repair the dorsal and pulp soft tissue defcts of the 3rd and 4th finge rs.The one stage operation is simple,practical and effective.
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Objective To report the long-term outcomes of repairing finger soft tissue defects using the dorsal metacarpal flap and compund flap. Methods Through a review of 122 cases,who were treated using the dorsal metacarpal flap and compound flap,the indication and long-term outcomes of the flap and characteristics of blood supply and compound tissues transferred and venous return were analyzed. Results All cases survived unevently.The fingers which were repaired using the flap were normal,and the contours of the donor sites were normal. Conclusions The dorsal metacarpal flap and compund flap are an optimal method to repair finger soft tissue defects.