The reverse dorsal metacarpal flap

The dorsal metacarpal vessels contribute to the fascial plexus which supplies the skin of the dorsum of the hand. We have successfully used eight reverse dorsal metacarpal flaps based on the dorsal metacarpal arteries. The design and use of the reverse dorsal metacarpal flap is described; it appears to have a reliable vascular basis and its usefulness in covering small soft tissue defects in the hand is illustrated.     

跨区供血的手部微型岛状皮瓣的设计和应用

目的：探索修复手指中节和末节皮肤缺损的新方法。方法：16例新鲜肢体血管灌注氧化铅－明胶混合液,通过X线片显示手背及指背皮肤内的血管结构和血管之间吻合类型。在此基础上设计并应用了两种不同的跨区供血的手部微型岛状皮瓣,1999年以来共应用14例（以指动脉侧支为蒂的掌背逆行岛状皮瓣8例和以指动脉背侧支为蒂的邻指背侧逆行岛状皮瓣6例）。结果：对指背及掌背皮肤进行解剖,结果表明指动脉背侧皮支与掌背动脉的指背支相互吻合形成皮下血管吻合支,是上述两种皮瓣的解剖基础。临床应用14例,皮瓣全部成活,皮瓣色泽、厚度与质地与手部受区皮肤接近。结论：跨区供血的手部微型岛状皮瓣扩大了指背和掌逆行岛状皮瓣的旋转弧度,为修复手指中节和末节皮肤缺损提供了一种新方法。     

双轴点掌背皮动脉皮瓣修复腕手指软组织缺损

目的探讨应用双轴点掌背皮动脉皮瓣修复腕或手指软组织缺损的手术方法及其疗效. 方法 1995年～2003年,通过解剖学研究发现,由掌背动脉发出的近侧及远侧皮支在皮下组织内形成恒定的弓状动脉吻合,以其近侧或远侧皮支为蒂,手背皮肤为供区,可形成顺行或逆行岛状皮瓣.临床应用了27例,采用顺行修复手背3例,皮瓣范围2.0 cm×4.0 cm～4.0 cm×6.0 cm;逆行修复手指24例,其中食指12例,中指6例,环指4例,小指2例,皮瓣范围 2.5 cm× 3.5 cm～3.0 cm×7.0 cm.供区均直接闭合. 结果术后皮瓣均成活.经1～3年随访,皮瓣外形及手功能满意,术后3个月开始恢复感觉,1年后恢复保护性感觉.供区外形及功能正常. 结论以掌背皮动脉为蒂的顺行或逆行皮瓣修复腕或手指软组织缺损,是一种较好的手术方法.     

掌、指背皮神经营养血管逆行岛状皮瓣修复手指皮肤缺损

目的 分析应用掌、指背皮神经营养血管蒂逆行岛状皮瓣修复手指皮肤缺损的疗效.方法 应用掌背皮神经营养血管蒂逆行岛状皮瓣18例(18块),带指神经背侧支的指背逆行岛状皮瓣15例(17块),修复手指皮肤缺损.观察皮瓣的成活率、质地、色泽和感觉.结果 术后皮瓣发生肿胀2例,静脉危象2例.33例35块皮瓣全部存活.术后随访时间为3～18个月,平均12个月.皮瓣外观、质地、弹性良好,有部分浅感觉恢复.结论 掌、指背皮神经营养血管蒂逆行岛状皮瓣不损伤主要血管、神经,操作简单,是修复手指创面的理想方法.     

封闭负压引流结合掌背动脉穿支皮瓣、掌长肌腱移植修复手背复合组织缺损

目的探讨封闭负压引流(VSD)技术结合逆行掌背动脉穿支岛状皮瓣、掌长肌腱移植修复手背复合组织缺损的临床疗效。方法应用VSD技术结合逆行掌背动脉穿支岛状皮瓣、掌长肌腱移植修复11例手背复合组织缺损患者。组织缺损面积1.8 cm×2.0 cm~3.0 cm×6.0 cm,切取皮瓣面积2.0 cm×2.5 cm~3.5 cm×7.0 cm。结果切取第2掌背动脉穿支岛状皮瓣7例,第3掌背动脉穿支岛状皮瓣2例,第4掌背动脉皮瓣皮支岛状皮瓣2例。皮瓣全部成活,无皮瓣感染病例。患者均获得随访,时间7~25个月。伤指关节功能、皮瓣外形较满意。末次随访时按手指总主动活动度(TAM)标准评估伤指功能:优6例,良3例,中2例。结论 VSD可有效控制创面炎症,结合逆行掌背动脉穿支岛状皮瓣、掌长肌腱移植修复手背复合组织缺损,外形及功能恢复满意、血运可靠,是一种较好的修复方法。     

Clinical application of the reversed pedicled venous flap containing perivenous areolar tissue and/or nerve in the hand.

A reversed pedicled venous flap containing perivenous areolar tissue and/or nerve was used to cover traumatic skin defects of seven fingers in six patients. The series consisted of six men, ranging in age from 20 to 57 years (average: 39 years). The reconstructed sites were four dorsal skin defects and three volar skin defects of the finger. The flap was designed on the dorsum of the hand, in such a way as to place a vein at the centre of the flap and not to involve the dorsal metacarpal artery. The flap contained a dorsal vein, perivenous areolar tissue and fascia of the interosseous muscle. Cutaneous nerves were present in three of the seven flaps. The pedicle of the flap was dissected distally to the finger web space and the flap was transferred to the skin defect. The size of the flap ranged from 1.4x4.5 cm to 6.0x7.0 cm. The average length of the pedicle was 1.6 cm. Skin grafting was needed at the donor site in one case (flap size: 6.0x7.0 cm), but primary closure was possible in the remaining cases. Postoperatively, the largest flap showed superficial necrosis, although it survived. The remaining flaps survived completely. This suggests that in a large flap the skin should be attached to the pedicle to prevent congestion. The flap can be elevated without reference to the dorsal metacarpal artery at the ulnar side of the dorsum of the hand. The flap is an effective option to reconstruct skin defects of the finger, especially the little finger.     

桡动脉腕背分支为蒂的手背逆行岛状筋膜皮瓣的临床应用

目的探讨手背部桡动脉腕背分支为蒂的三种逆行岛状筋膜皮瓣的手术方法及临床应用。方法桡动脉在腕背鼻烟窝穿出,与尺动脉掌深弓吻合之前,发出腕背皮支、第1掌背动脉、拇指背侧支以三支动脉为蒂,形成逆行鼻烟窝皮瓣、第1掌背动脉皮瓣、拇指背侧动脉皮瓣,修复虎口挛缩和指、示指、腕掌、腕背侧皮肤缺损。结果切取桡动脉腕背皮支逆行岛状皮瓣13例,修复拇指、虎口、指、腕掌、腕背组织损伤及缺损。术后随访皮瓣外形及手功能恢复效果满意。结论桡动脉腕背分支行岛状筋膜皮瓣血运好,质地柔软,切取方便,不牺牲主要动脉,是修复手部皮肤缺损的一种简单安全、损伤小的方法。     

吻合神经的手部皮神经营养血管皮瓣修复指端软组织缺损

目的 报道应用吻合神经的手部皮神经营养血管皮瓣修复手指指端软组织缺损的临床效果.方法 采用掌背皮神经营养血管皮瓣掌侧移位修复拇指指端软组织缺损;拇指尺背侧皮神经营养血管皮瓣修复示指指端软组织缺损:中、环、小指指背皮神经营养血管皮瓣修复相应指端软组织缺损;共修复指端软组织缺损56例. 结果 皮瓣全部成活,随访6个月～3年,皮瓣质地柔软、弹性好、耐磨;指端饱满,色泽正常,两点辨别觉5.4～9.6 mm,45例感觉恢复至S3,11例至S4,外观及功能满意.结论 应用吻合神经的手部皮神经营养血管皮瓣修复手指指端软组织缺损,效果良好.     

指背旗形静脉皮瓣的设计与应用

目的根据指背静脉及静脉弓的解剖特点,改进旗形皮瓣的设计与应用。方法利用桡侧或尺侧指背静脉为轴心静脉,用逆行设计法,为6例指掌侧与手掌侧相联的缺损设计了旗形静脉皮瓣修复。结果全部成活,伤口Ⅰ期愈合。随访3个月,手指活动及外形良好。结论此类皮瓣可Ⅰ期同时修复指掌侧和手掌侧皮肤缺损,扩大了旗形皮瓣的应用范围。     

指背旗形静脉皮瓣的设计与应用

目的根据指背静脉及静脉弓的解剖特点，改进旗形皮瓣的设计与应用。方法利用桡侧或尺侧指背静脉为轴心静脉，用逆行设计法，为６例指掌侧与手掌侧相联的缺损设计了旗形静脉皮瓣修复。结果全部成活，伤口Ⅰ期愈合，随访３个月，手指活动及外形良好。结论此类皮瓣可Ⅰ期同时修复指掌侧和手掌侧皮肤缺损，扩大了旗形皮瓣的应用范围。     

Free dorsal middle phalangeal finger flap

Three patients underwent finger reconstruction using free dorsal middle phalangeal finger flaps (DMF flaps). All flaps survived. The free DMF flap relies on blood flow from the dorsal branches of the digital artery and is harvested from the skin on the dorsum of the middle phalanx. The digital artery gives rise to four dorsal branches; two in the middle and two in the proximal phalangeal regions. The flap is based on the dorsal branch of the digital artery that passes near the center of the phalanx. The characteristic feature of the free DMF flap is that the dorsal cutaneous veins are used as drainage vessels. Unlike island flaps, blood congestion does not occur after free DMF flap surgery. Sensibility of the free flap may be obtained by inclusion of the dorsal branches of the digital nerves in the flap pedicle. Loss of the digital artery at the donor site can be circumvented with venous grafting. Surgery under brachial plexus block is an advantage of this flap. The free DMF flap is a useful technique for skin and soft-tissue defects.     

Reversed dorsal digital and metacarpal island flaps supplied by the dorsal cutaneous branches of the palmar digital artery

The dorsal digital and metacarpal island flaps have been described for use in a variety of clinical situations. On the basis of the authors' previous angiographic studies, these two skin flaps were planned on the dorsum of the proximal phalanx or intermetacarpal space based on the vascular anastomoses between the proximal dorsal cutaneous branches of the palmar digital artery and the dorsal digital branches of the dorsal metacarpal artery at the level of the proximal phalanx. The authors present a series of 13 patients using these flaps. To reconstruct the injured finger pulp, the reverse dorsal digital flap was used in 5 patients, and the reverse dorsal metacarpal flap was used in 8 patients. Most of the 13 patients sustained a work-related injury. Associated injuries of bone, joint, or tendon occurred in most patients. In all patients, the skin defect was located distal to the proximal interphalangeal joint. The skin paddle was taken from the dorsal aspect of the middle and ring fingers or the first, second, third, and fourth metacarpal area. All flaps survived completely. Two patients who had the dorsal branch of the sensitive radial nerve anastomosed to the digital nerve recovered 6-mm two-point discrimination in the reverse dorsal digital flap. The results of this anatomic study and the authors' clinical experience confirm the reliability of the dorsal digital and metacarpal island flaps.     

指背旗形静脉皮瓣的设计与应用

目的 根据指背静脉及静脉弓的解剖特点，改进旗形皮瓣的设计与应用。方法 利用桡侧或尺侧指背静脉为轴心静脉，用逆行设计法，为６例指常侧与手常侧相联的缺损设计了旗形静脉皮瓣修复。结果 全部成活，伤口Ｉ期愈合，随访３个月，手指活动及外形良好。结论此类皮瓣可Ｉ期同时修复指掌侧和手掌侧皮肤缺损，扩大了旗形皮瓣的应用范围。     

Reverse-flow first dorsal metacarpal artery flap for index fingertip reconstruction

Dorsum of the hand is an ideal skin-flap donor site for coverage of hand or finger defects. We elevated 8 reverse-flow first dorsal metacarpal artery flap in 9 patients for soft-tissue cover of index fingertip injuries distal to distal interphalangeal joint with exposed bone. In 3 patients, the digital branch of the superficial radial nerve was coapted to the digital nerve. All flaps healed uneventfully, except for 1 patient in which partial necrosis of the flap occurred. Postoperative follow-up was 4-12 months (mean, 8 months). Reverse-flow first dorsal metacarpal artery flap is a good alternative for reconstruction of index fingertip injuries.     

指背血管蒂岛状皮瓣修复拇指组织缺损

目的 探讨拇指组织缺损的修复方法。方法 利用8具尸体16只手进行解剖学研究，观察了拇指背动脉、第1掌背动脉及食指桡侧指背动脉。临床上分别以拇指背动脉、示指桡侧指背动脉为蒂于手背侧设计岛状皮瓣进行应用。结果 拇指背动脉外径0．24～0．46mm，平均0．37mm，示指桡侧指背动脉0．26～0．56mm，平均0．44mm，血管恒定。临床应用拇指背血管蒂逆行皮瓣、示指桡侧指背血管蒂皮瓣修复拇指组织缺损12例；皮瓣带人桡神经指背支形成有感觉皮瓣，效果更满意。结论 以指背血管为蒂的手背侧皮瓣是修复拇指组织缺损的较为理想方法。     

Correction of thumb deformities after burn: versatility of first dorsal metacarpal artery flap

In the management of a debilitated burned hand due to contractures, thumb reconstruction constitutes the most crucial part for a beneficial functional outcome. Among the limited local flap alternatives for the thumb, the first dorsal metacarpal artery flap, harvested from the dorsal aspect of the index finger can provide elastic, durable and sensate coverage for soft tissue defects after contracture release. In a 3-year period, neurovascular island first dorsal metacarpal artery flap was used in 14 patients suffering thumb deformities. The time elapsed after the underlying injury until reconstruction ranged from 5 months to 17 years. Follow-up revealed that all deformities were successfully treated with satisfactory functional recovery and cosmetic results. Donor site morbidity was minimal with an acceptable scar on the dorsum of the index finger and adequate tendon gliding without producing extension deficit. Our experience with management of deformities involving the thumb and/or adjacent thenar area revealed that the first dorsal metacarpal artery flap is a reliable local neurovascular island flap option, offering acceptable functional and cosmetic outcomes in respect to sensation, elasticity, durability and skin-match.     

The distally-based dorsal hand flap

The planning and clinical applications of a series of reverse dorsal hand flaps are described. This new flap is based on a direct cutaneous branch of the dorsal metacarpal artery. It is particularly useful in resurfacing web spaces as well as dorsal metacarpal and phalangeal skin defects. The behaviour of 21 such flaps, all raised in the form of an island, was that of a conventional axial pattern flap.     

掌背动脉逆行岛状皮瓣修复多指皮肤缺损

目的报道应用掌背动脉逆行岛状皮瓣修复多手指软组织缺损的方法。方法应用掌背动脉逆行岛状皮瓣修复手指软组织缺损16例38指。结果术后16例38块皮瓣全部存活。随访时间为4个月～1年，皮瓣外形优良，不臃肿，皮瓣两点分辨觉为5～9mm。供区植皮成活，掌背有环形瘢痕，少许色素沉着。结论掌背动脉逆行岛状皮瓣操作方便，易切取，损伤小，不牺牲主干动脉，手术可同时切取多块皮瓣修复多指软组织缺损，是修复多手指皮肤软组织缺损的良好方法。     

掌背动脉筋膜瓣修复手指背侧组织缺损

目的 报道应用带掌背动脉的筋膜瓣加游离植皮修复手指背侧组织缺损的临床疗效.方法 2003年12月-2009年12月共治疗手指背侧组织缺损36例,根据手指指背软组织缺损情况,分别采用了顺行带掌背动脉筋膜瓣（10例）、逆行带掌背动脉筋膜瓣（20例）和U-I型掌背动脉筋膜瓣（6例）进行修复.筋膜瓣面积：1.2cm×2.1cm～2.5cm×4.5cm.结果 36例筋膜瓣加植皮区全部成活,术后随访1～12个月,平均6个月,其中31例外形和功能恢复较为满意（86 %）,5例不满意（14%）.结论 选用带掌背动脉筋膜瓣加游离植皮修复手指背侧组织缺损,具有手术操作相对简便,对供区影响小,外形良好,不损伤指固有动脉及神经等优点,可一、二期修复手指背侧不同部位的皮肤缺损.     

Clinical study of dorsal ulnar artery flap in hand reconstruction

Soft tissue defects of hand with exposed tendons, joints, nerves and bone represent a challenge to plastic surgeons. Such defects necessitate early flap coverage to protect underlying vital structures, preserve hand functions and to allow for early rehabilitation. Becker and Gilbert described flap based on the dorsal branch of the ulnar artery for defects around the wrist. We evaluated the use of a dorsal ulnar artery island flap in patients with soft tissue defects of hand. Twelve patients of soft tissue defects of hand underwent dorsal ulnar artery island flap between August 2006 and May 2008. In 10 male and 2 female patients this flap was used to reconstruct defects of the palm, dorsum of hand and first web space. Ten flaps survived completely. Marginal necrosis occurred in two flaps. In one patient suturing was required after debridement and in other patient wound healed by secondary intention. The final outcome was satisfactory. Donor areas which were skin grafted, healed with acceptable cosmetic results. The dorsal ulnar artery island flap is convenient, reliable, and easy to manage and is a single-stage technique for reconstructing soft tissue defects of the palm, dorsum of hand and first web space. Donor site morbidity is minimal, either closed primarily or covered with split thickness skin graft.