Use a leaflet flap of foot to severed multi-finger with segmental injury / 中国骨伤

OBJECTIVE@#To explore asurgical methods for replantation of severed finger.@*METHODS@#From January 2018 to November 2022, 8 amputated-finger patients were performed surgical reconstructions by using polyfoliate free flaps with the first dorsal metatarsal artery, including 7 males and 1 female, aged from 20 to 55 years old, and defect areas ranged from (1.0 to 2.0) cm×(3.0 to 4.5) cm. Finger pulp sensation, shape and other relevant parameters were assessed following the upper extremity functional evaluation standard, which was put forward by Hand Surgery Branch of Chinese Medical Association. And maryland foot functional score was used to evaluate foot function.@*RESULTS@#Amputated fingers and flaps of all the 8 patients were survived. All patients were followed up for 4 to 20 months, their finger color and temperature tured to normal, with good wear-resistance and cold-resistance. According to Hand Surgery Branch of Chinese Medical Association, functional score ranged 61 to 92;4 patients got excellent result and 4 good. Maryland foot functional score ranged from 93 to 100;and 8 patients got excellent result.@*CONCLUSION@#It is feasible to repair severed fingers with soft tissue defects using polyfoliate free flaps that driven by the flippers of the first and second toes of the foot. This method ccould bridge blood vessels, increase soft tissue volume of the injured finger, and avoid finger shortening, with high patient satisfaction.

Variations in Innervation Pattern to Dorsum of Foot by Medial Dorsal Cutaneous Nerve, Intermediate Dorsal Cutaneous Nerve, Lateral Dorsal Cutaneous Nerve with Surgical and Clinical Correlations: A Cadaveric Dissection Based Study

The complete reconstruction of any soft tissue defect includes even the sensory recovery which is very significant aspect pertaining to prognosis. Superficial nerves in the vicinity of the vascular axis can be considered as vascular relays and neuroskin grafts can be constructed on them. Variations in innervation to various part of the dorsum of the foot by this nerve should be kept in mind while making these grafts. Authors dissected 50 formalinized cadaveric feet and studied normal anatomy and variations in origin, course, branching pattern, communications, and any other variations in medial, intermediate and lateral dorsal cutaneous nerve. The intermediate dorsal cutaneous nerve was innervating larger area of the skin around 3rd and 4th web spaces in 60% of cadaveric feet. The 2nd web space was innervated by medial dorsal cutaneous nerve in 92% of cadaveric feet. In 52% of cadaveric feet communicating branches were found between intermediate dorsal cutaneous nerve and lateral dorsal cutaneous nerve. In 63% cadaveric feet communicating branches were found between medial dorsal cutaneous nerve and branch of deep peroneal nerve to 2nd web space. The mean distance between lateral malleolus and intermediate dorsal cutaneous nerve was 4.05cm. These all observations can provide anatomical basis at the time of preparing medial dorsal cutaneous nerve flaps and intermediate dorsal cutaneous nerve flaps and also can minimize morbidity at donor site.

Repair of two soft tissue defects on the same finger by a pedicled tandem flap with first dorsal metatarsal artery-second toe tibial artery in series / 中华显微外科杂志

Objective:To investigate the technique and clinical effect of repairing 2 soft tissue defects on the same finger with a pedicled tandem flap of the first dorsal metatarsal artery and the second toe tibial artery.Methods:From March, 2018 to May, 2020, 8 patients, which were 5 males and 3 females, with 2 soft tissue defects in the same finger, were repaired with the first dorsal metatarsal artery flap in series with the second toe tibial flap. The causes of injury: 4 by crush, 2 by heavy object, and 2 by thermal press. There were 4 defects on index fingers, 2 on middle fingers and 2 on ring fingers. The defects ranged from 2.0 cm×2.5 cm to 2.5 cm×3.0 cm. All defects had exposed bone or tendon at varying degrees and 3 with phalanx fractures. Three patients underwent emergency surgery, the other 5 had sub-emergency surgery which were performed 3 to 5 days after the injury. The size of the flaps was 2.0 cm×2.5 cm to 3.0 cm×3.5 cm. The donor sites were sutured directly in 3 patients and 5 patients received skin grafting. The regular follow-up was performed. The survival of flaps, character, feeling and Total active motion(TAM), recovery of the foot donor area and complications were observed.Results:The operation time ranged from 2.0 to 5.5 hours, with an average of 3.5 hours. No vascular crisis occurred and all flaps survived after the surgery. All patients entered follow-up for 3-20 months, with an average of 8 months. The flaps had a good plump appearance, soft texture, good elasticity, and with a high similarity to the surrounding skin. The TPD of the flaps was 6-15 mm, with an average of 8 mm. The fingers had good flexion and extension functions. The incision in the donor site of the foot healed by first intention. The walking, running and jumping were normal without pain or discomfort.Conclusion:The first dorsal metatarsal artery-second toe tibial artery tandem flap has been used to repair 2 soft tissue defects in same finger. It simplifies the revascularisation of the flap together with exact surgical curative effect.

The Innervated Distally Based First Dorsal Metatarsal Artery Flap with a Wide Pedicle for Reconstruction of a Great Toe Defect

BACKGROUND: It is difficult for surgeons to reconstruct soft tissue defects of the great toe. This report aims to evaluate the utility and efficacy of innervated distally based first dorsal metatarsal artery (FDMA) flap with a wide pedicle for reconstruction of soft tissue defects of the great toe. METHODS: This is a retrospective report. Between January 2015 and December 2017, six cases of skin defect of the great toe were reconstructed with an innervated distally based FDMA flap with a wide pedicle. One case was excluded in this report because of chronic pain on the metatarsophalangeal joint due to osteoarthritis before the injury. A total of five cases were evaluated for flap survival and sensory recovery. The sensory recovery was investigated by two-point discrimination and Semmes-Weinstein monofilament tests. The average age of the selected patients was 40 years (range, 36 to 56 years), and the average size of the defect in the toe was 8.3 cm2 (range, 4 to 13.8 cm2). The average follow-up period was 29.4 months (range, 18 to 38 months). RESULTS: All patients survived without any complications. The average two-point discrimination test value was 8.0 ± 0.89 mm (range, 7 to 9 mm), and the average value obtained from the Semmes-Weinstein monofilament test was 4.53 ± 0.33 (range, 4.17 to 4.93). The average residual pain score evaluated with a visual analog scale was 1 (range, 0 to 2). Two patients complained of stiffness in the great toe below 30° of total range of motion during the early stages after surgery, but this stiffness gradually improved after rehabilitation. The average range of motion of three patients with a remaining metatarsophalangeal joint after surgery was 80° (range, 70° to 90°). All five cases could walk regularly without any unique footwear at the final follow-up. CONCLUSIONS: The innervated distally based FDMA flap with a wide pedicle could be a good alternative method for repair of soft tissue defects of the great toe.

Forefoot reconstruction in application of the reverse dorsal metatarsal artery perforator flap: 43 cases report / 中华显微外科杂志

Objective To discuss the clinical application of reverse dorsal metatarsal artery perforator flap for reconstruction of forefoot soft tissue defects.Methods Since January,2008 to March,2016,43 patients with forefoot soft tissue defect due to various causes were reconstructed with the flap based on dorsal metatarsal artery perforator.Dorsal pedis was used as a donor site with dorsal metatarsal artery perforator as the donor artery.The flap size varied from 2.0 cm × 4.0 cm to 6.0 cm × 8.0 cm.Among them,27,8,4 and 4 cases were reconstructed with flap based on first,second,third and fourth dorsal metatarsal artery perforator flap respectively.Results All the patients were followed-up which ranged from 3 months to 24 months.Six flaps suffered from post operative venous congestion.Out of 6,4 survived with early emergency management while the remaining 2 suffered epidermal necrosis which survived with regular dressing change.Eventually,all the flaps survived.They had good texture and they were elastic,good-looking and very wear-resisting.Walking function was normal.Conclusion Reverse dorsal metatarsal artery perforator flap is an ideal choice in reconstruction of small to medium sized soft tissue defects of forefoot.

Reconstruction of palmar finger soft tissue defects by using first dorsal metatarsal artery Flow-through flap with digital artery and nerve anastomosis / 中华显微外科杂志

Objective To investigate the treatment of outcomes of repairing soft tissue defects of the palmar finger accompanied by proper digital artery and nerve defects.Methods From January,2014 to June,2016,7 patients(4 males and 3 females.Patients'age ranged from 18 to 45 years,with an average of 28.5 years) with soft tissue defects on the palmar side of the proximal and middle phalanx of the fingers accompanied by proper digital artery and nerve defects were treated by first dorsal metatarsal artery Flow-through flap,application of color Doppler ultrasound was used in the detection of vascular type before operation.The flap area was from 2.0 cm×2.5 cm to 3.5 cm×5.5 cm.All the donor site of the flap were sutured directly.The patients were followed-up in 1 month,3 months,6 months,12 months,24 months after the surgery,and the results were evaluated according to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association.Results All flaps survived.These cases were followed-up for 6 to 24 months,average 12 months.All the flaps got satisfactory appearance and good sense function,and 2-PD of the flap averaged 7 mm,ranging from 6 mm to 12 mm.All injured fingers got satisfactory appearance and good sense function,2-PD of the injured fingers averaged 8 mm,ranging from 6 to 15 mm.The donor site incision healed well no obvious scar hyperplasia,good function.Conclusion Application of the first dorsal metatarsal artery Flow-through flap to reconstruct soft tissue defects of the palmar finger accompanied by proper digital artery and nerve defects,can achieve good clinical effects.This method can restore the appearance,blood supply and sensation of the injured finger.

The free twin-flap with the first metatarsal dorsal(bottom) artery repair the defects of distal in adjacent two fingers / 中华显微外科杂志

Objective To explore the clinical effect that the free twin-flap with the first dorsal (bottom) metatarsa artery repair the defects of distal in adjacent two fingers.Methods The twin-flap from the big toe and the second toe based on a single vascular pedicle of the firstl dorsal (bottom) metatarsa artery was designed in this article.From November 2010 to June 2013,this twin-flap was transferred in 9 patients.In order to solve the problems:the shortage of arterial span,the bone and (or)tendon exposed in the donor site,the thickness skin graft resurfaced in the donor site was not easy to survive,the bare vascular pedicle and the donor site were covered with artificial dermis for 3 weeks.After 3 weeks,cutting skin bridge and removing the thin of artificial dermis,the donor site was resurfaced by thickness skin graft.Results All cases were followed up for 4 to 12 months.All transfering flaps and the thickness skin graft were survival.The colours and texture of the flaps matched the recipient site.2-point discrimination ranged from 8 to 12 mm.Finger flexion and extension was satisfactory.The appearance of the donor site was well-stacked.No case had successive ulces,pain and car.Conclusion The twin-flap from the big toe and the second toe based on a single vascular pedicle of the first dorsal (bottom) metatarsal artery combined with artificial dermis to repair the defects of distal in adjacent two fingers.For one side,this operation can solve he shortage of arterial span and repair the defects of distal in adjacent two fingers at the same time.For another,it can provid a easy method for deal with the donor site and raise the survial rate of the thickness skin graft.Besides,it also is easy and safe,clinical effect is satisfaction.

Anatomical review of dorsalis pedis artery flap for the oral cavity reconstruction

The dorsalis pedis artery (DPA) was renamed from the anterior tibialis artery after it passed under the extensor retinaculum, and DPA travels between the extensor hallucis longus and extensor digitorum longus muscle along the dorsum of the foot. After giving off the proximal and distal tarsal, arcuate and medial tarsal branches, DPA enters the proximal first intermetatarsal space via the first dorsal metatarsal artery (FDMA), which courses over the first dorsal interosseous muscle (FDIM). For detailed knowledge of the neurovascular anatomy of a dorsalis pedis artery flap (DPAF) as a routine reconstructive procedure after the resection of oral malignant tumors, the precise neurovascular anatomy of DPAF must be studied along the DPA courses as above. In this first review article in the Korean language, the anatomical basis of DPAF is summarized and discussed after a delicate investigation of more than 35 recent articles and atlas textbooks. Many advantages of DPAF, such as a consistent flap vascular anatomy, acceptable donor site morbidity, and the ability to perform simultaneous flap harvest using oral cancer ablation procedures, and additional important risks with the pitfalls of DPAF were emphasized. This article will be helpful, particularly for young doctors during the special curriculum periods for the Korean National Board of Specialists in the field of oral and maxillofacial surgery, plastic surgery, otolaryngology, orthopedic surgery, etc.

An anatomical study and clinical application of free transfer of foot tissues pedicled with plantar metatarsal artery / 中华创伤骨科杂志

Objective To explore a new method of functional reconstruction of hand digits and joints with free transfer of foot tissues so as to increase the success rate of the operation.Methods After micro-anatomic study of the plantar and dorsal metatarsal arteries,retrograde and free grafts of foot tissues pedicled with plantar metatarsal arteries were designed and applied in transplantation to treat 76 cases of hand digital or joint defects.The surgeries included 58 cases of transfer of the second toe,four cases of transfer of composite tissues of the second toe, eight cases of transfer of proximal interphalangeal joint,and six cases of nail flap transfer.Results The mi- cro-anatomic study found that the first plantar metatarsal artery was anatomically constant and the diameter of its branch to the second toe was larger than that of the first dorsal metatarsal artery.Flaps survived in 75 of the 76 patients(98.7%),with fine appearance and significantly improved function.One patient who had received free transfer of the second toe to reconstruct the thumb function had to undergo a second repair with infraclavicula skin tube because of refractory arteriospasm of anastomosed vessels.Conclusion Transfer with free retrograde grafts of foot tissues pedicled with plantar metatarsal artery to reconstruct hand functions can effectively improve the success rate of the operation,because it is free of the shortcomings of great anatomic variation of blood vessels and time-consuming and complex procedures in conventional transfer.

The method of tracing the first dorsal metatarsal artery at the layer superficial to the extensor expansion in thumb and finger reconstruction / 中华创伤骨科杂志

Objective To clarify the relationship between the first metatarsal web space and associated vessels and its application in dissection of the toes for thumb and finger reconstruction. Methods The relationships of the first dorsal metatarsal artery to the first deep transverse metatarsal ligament and the extensor expansion were observed on 42 adult cadaver lower limbs. Clinically 36 cases of thumb defects were reconstructed using the method of tracing the first dorsal metatarsal artery around the space of extensor expansion to dissect toes. Results The distal segment of the first dorsal metatarsal artery of Gilbert type I and type Ⅱwas located superficially to the layer of the extensor expansion.The time of harvesting the toe was shortened from 90 minutes to 50 minutes with 100%survival of reconstruction. Conclusions The distal segment of the first dorsal meatarsal artery lies constantly to the superficial layer of the extensor expansion.Consequently the location of the first metatarsal artery of Gilbert type I and type Ⅱbecomes much easier, by adopting the method of combination of sequential dissection and reverse dissection around the space of the extensor expansion.

Reconstruction of Soft Tissue Defect of the Finger with Second Dorsal Metatarsal Arterial Flap

To cover a large soft tissue defect of the finger, we have successfully applied free flaps using second dorsal metatarsal artery in 2 patients and obtained satisfactory results. It can be used to reconstruct the defect located from the proximal phalanx to the fingertip of all fingers as a new indication. The procedure is a time-saving, one stage operation. It also causes no disfigurement and no functional loss of the involved digit. Our clinical experience showed favorable results. Second dorsal metatarsal artery free flap is an alternative method to reconstruct a soft tissue defect of the finger with one-stage operation. This flap with its lengthy pedicle provides enough tissue padding. In the meantime, the vascular anatomy of the second dorsal metatarsal artery has to be investigated with regard to its general distribution and variation.

Morphological Study on the Dorsalis Pedis and First Dorsal Metatarsal Arteries in Koreans / 대한해부학회지

Morphological variation of the dorsalis pedis and the first dorsal metatarsal arteries are important because these arteries are used as flap pedicles during surgery of hands and feet with tissue defects. The purpose of this study was to investigate variations in the running pattern of the dorsalis pedis and first dorsal metatarsal arteries. We investigated the dorsalis pedis artery in 92 adult cadaver feet and 50 first dorsal metatarsal arteries that arose from these dorsalis pedis arteries were studied. The dorsalis pedis artery was classified into six types according to its running direction. The dorsalis pedis artery running in the direction of the first intermetatarsal space and branching into the first dorsal metatarsal artery was observed in 79.3%. The dorsalis pedis artery coursing laterally and becoming the first dorsal metatarsal artery after changing its direction medially was seen in 5.4%. The dorsalis pedis artery was thin and did not connect to the first dorsal metataral artery, split in the region of ankle and came to an end, and ran laterally and did not connect to the first dorsal metatarsal artery in 8.7%, 2.2%, and 3.7%, respectively. The dorsalis pedis artery ran superficial to the deep fascia in 1 of the 92 specimens (1.1%). The first dorsal metatarsal artery was classified into three types according to the positional relationship between the first dorsal metatarsal artery and the first dorsal interosseous muscle. The first dorsal metatarsal artery ran above or into the first dorsal interosseous muscle in 72% and ran below the first dorsal interosseous muscle in 22%. The first dorsal metatarsal artery that was either above or inside the first dorsal interosseous muscle but could not used as a flap pedicle because it was too small was seen in 6%.

Applied anatomy of the great/second toe web flap for reconstruction the defect in commissure of lips of mouth / 中华显微外科杂志

Objective To provide an ideal tissular flap for the soft tissue defects of the oral commissure. Methods The observation and measurement of the source of blood supply and nerve innervation to the great/second toe web was carried out on 40 sides of adult specimens lower limbs perfused with red latex in artery. Results The first dorsal metatarsal artery which originated from the dorsal pedal artery was the chief artery to this region. Its external diameter at the beginning was (l. 6 ? 0. 3) mm and was (4. 6?0. 6) cm in length. Sensory nerve of the flap is deep peroneal nerve Conclusion The great/second toe web flap was an ideal tissue defects of the oral commissure.