ABSTRACT
Objective:To explore the method and effect in repairing the defect of fingertip with lateral V-Y advancement flap with one side palmar proper digital artery.Methods:From October 2014 to May 2019, Department of the Hand and Foot Surgery, the Third People's Hospital of Jining(Yanzhou District People's Hospital of Jining City) treated 34 digits of 27 cases with a defect area of 0.5 cm×0.5 cm-1.5 cm×2.0 cm. A lateral V-Y advancement flap with one side palmar proper artery was used to repair the fingertip defect, and the flap size was 1.7 cm×1.0 cm-4.5 cm×1.5 cm. Twenty cases entered long-time follow-up after operation, with 7 cases lost in follow-up, 16 cases were reviewed at outpatient and 4 by WeChat.Results:All the flaps of 34 digits of 27 cases survived. The color of the flaps were close to or completely normal to the surrounding tissue, the texture was soft and the appearance was good. The TPD of the flap was 2.0-6.0 mm. The follow-up time ranged from 22 to 77 months, with an average of 31.45 months. The flexion and extension function of the digits were good with total range of motion(ROM) of the thumb was > 90 °; total active motion (TAM) of the fingers was 260 °-200 °. The fingers of 1 case had hook nail or hook finger deformity. According to the Evaluation Trial Standard of Upper Limb Partial Function of Hand Surgery of Chinese Medical Association, 18 cases were excellent and 2 cases were good.Conclusion:The lateral V-Y advancement flap with one side palmar proper digital artery is easy to operate. The blood supply of the flap is reliable, with good sensation. The flexion and extension of the digits are good, and the appearance and texture of the flap are good.
ABSTRACT
Objective To evaluate the clinical effect of treatment for deep burn wound on finger by proper digital artery flap.Methods From March 2013 to October 2016, 24 patients with deep burn wound on finger were treated by proper digital artery flap.Postoperative observation included wound repair, flap survival, complications and functional recovery of fingers.Results All the 24 flaps survived and no necrosis happened.The marginal abnormal circulation of flap occurred in only 5 cases, which cured by dress changing.All flaps kept well in contour, skin color, temperature and texture.Movement function of donor and recipient fingers was nearly normal.Conclusion Proper digital artery flap avoided the deficiencies distant pedicled flap, so it is a favorite choice for digital soft tissue defect caused by deep burn injury.
ABSTRACT
Superficial palmar arterial arch is an arterial arcade, which is a dominant vascular structure of the palm. It is defined as the anastomoses between the superficial branch of the ulnar artery and the superficial palmar branch of the radial artery. The superficial palmar arch completed by anastomosing with one of the branches of radial artery, i.e. with arteria radialis indicis, arteria princeps pollicis, arteria nervi mediana. The present study reporting a variation of superficial palmar arch which is formed alone by superficial branch of ulnar artery and it is also giving branches to radial side of index finger and to the thumb. Normally the branch to the radial side of index finger receives branch from superficial terminal branch of radial artery and it is known as arteria radiclis indicis. The ARI was given by ulnar artery from the terminal part of radial side along with the princeps pollicis branch. The knowledge of variations of the vascular arches warrants the surgeons while performing surgeries on hands, such as arterial repairs, vascular graft applications.
ABSTRACT
Objective To investigate the effect of repairing soft tissue defects in the middle and distal phalanx with the reverse dorsal metacarpal and digital fasciocutaneous flap based on the dorsal cutaneous branches of the proper digital artery. Methods Twenty-five fingers with soft tissue defects in the middle and distal phalanx were repaired by the reverse dorsal metacarpal and digital fasciocutaneous flaps based on the dorsal cutaneous branches of the proper digital artery from June 2007 to June 2009. Their pivot points were located at the midpoint or distal segment of proximal phalanx. Results Among 25 flaps, 24 survived completely, but cuticular layer in the distal part of one flap was partially necrotic. Twenty flaps were followed up from 12 to 18 months after operation. All flaps were characterized by rich blood supply, cold-resistance, suitable thickness, soft texture and good colour, except that 6 flaps required a secondary operation because of their fat and clumsy pedicel. There was no adhesion of extensor tendon and contraction of interdigital web in the donor sites. Two-point discriminations of anastomosing cutaneous nerve ranged from 6 mm to 10 mm in 5 of the 20 flaps, and 8 mm to 14 mm in the other 15 flaps. Conclusion The dorsal metacarpal and digital fasciocutaneous flap based on the dorsal cutaneous branches of the proper digital artery is an ideal option for repairing soft tissue defects of middle and distal phalanx because of its advantages of easy and secure dissection, reliable blood supply, longer arch of rotation, being closer to the raw surface of finger, less injury to the donor site, good appearance, avoidance of sacrificing major arteries ,and high probability of reconstructing flap sensation by anastomosing cutaneous nerve.