The anatomical basis and clinical application of free wrist crease flap / 中华显微外科杂志

ABSTRACT

Objective To summarize the cutaneous branches of the superficial branch of radial artery distribution were dissected and to discuss the operational technique and clinical efficacy of repairing hand tissue defect by the flap based on the superficial branch of radial artery.Methods From May,2014 to February,2017,8 fresh hand specimens perfused with red latex to observe the distribution and characteristics.And 24 cases of fingers tissue defects (3 thumbs,6 index fingers,5 middle fingers,9 ring fingers,and 1 litter finger) which were repaired with the free wrist crease flap based on the cutaneous branches of superficial palmar branch of the radial artery.Combined fracture in 5 cases.Combined rupture or defect of the flexor tendon in 8 cases.Combined vascular nerve injury in 6 cases.The maximum area of the flap was 5.5 cm × 3.2 cm,and the minimum was 2.0 cm × 1.5 cm.Regular followedup was performed after operation.Results Superficial palmar branch of the radial artery came from the level of radial styloid process ulnar palmar then through ulnar of tubercle of scaphoideum and tended to the thenar muscle.It gave 1-3 branches of the direct skin perforators at distal wrist crease and the anatomical location was constant.The vascular pedicle length could achieve 2.0-3.2 cm.All flaps were survived uneventfully.Twenty-four cases were followed-up for 6-29 months (mean,18.6 months),and the appearance and functional recovered satisfactorily.Flap sensation recovered to S3+.The 2 point discrimination was 8-13 mm.There was no complication in donor area.According to the fingers total active motion (TAM) method to assessexcellent in 17 cases,good in 5 cases,fair in 2 cases.The excellent and good rate was 91.7％.Conclusion The wrist crease cutaneous branches of superficial palmar branch of the radial artery anatomical location is constant.And the flap based on the artery has a reliable blood supply.The vascular pedicle flap is long enough and the operational technique is easy and safe.The postoperative effect is satisfied.It is an ideal method for repairing finger tissue defect.