A dynamic myocutaneous flap for hand reconstruction

Relocation of functional units by neurovascular pedicle transfer is firmly established in reconstructive hand surgery. Transfer of muscle and overlying skin, the myocutaneous flap, to provide skin cover is equally established. The dynamic myocutaneous flap is an extension of these concepts. Injection studies confirmed that the abductor digiti quinti muscle and its overlying hypothenar skin could be transferred on its neurovascular bundle. This dynamic myocutaneous flap was used to reconstruct both skin cover and functional opposition following resection of an arteriovenous malformation involving the thumb. Other clinical applications would include reconstruction of thenar skin and muscle lost secondary to electrical burns, avulsion, or tumor resection.     

Restoration of sensation using a local neurovascular island flap as a primary procedure in extensive pulp loss of the fingertip

A technique using a local composite neurovascular island flap, raised on the volar digital vessels and nerve, is described as a primary procedure for the reconstruction of extensive pulp loss of the fingertip. The results of this technique have been uniformly satisfactory in 8 patients.     

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.     

拇指指腹缺损的显微外科修复

目的 探讨含感觉神经的微型皮瓣修复拇指指腹缺损的临床疗效.方法 2000年2月-2010年3月,采用食指背岛状皮瓣、中指侧方岛状皮瓣、以桡侧指动脉为蒂逆行岛状皮瓣、桡动脉掌浅支为蒂的逆行皮瓣、拇指尺背侧动脉逆行皮瓣、拇指背皮神经营养血管皮瓣、第2趾趾腹皮瓣、？？趾甲皮瓣、大鱼际部浅静脉动脉化逆行皮瓣共9种皮瓣修复重建拇指指腹缺损134例.结果 3例皮瓣坏死,131例成活,6个月～1.5年随访108例,皮瓣外形血供充分,质地柔软,感觉测定S2～S4＋,两点辫别觉6～11mm.结论 采用含感觉神经的微型皮瓣修复拇指指腹缺损,对供区影响小、效果佳、为理想的术式选择.     

The second dorsal metacarpal artery neurovascular island flap

The clinical applications of the second dorsal metacarpal artery island flap are illustrated by selective case reports from a series of 12 consecutive cases carried out in this Unit. In five cases the flap was transferred as a neurovascular island flap for sensory resurfacing of the thumb. There were no failures and no donor site complications. The anatomy and clinical dissection of the flap are described.     

不同术式的指动脉岛状皮瓣修复指腹缺损

目的探讨不同术式的指动脉岛状皮瓣修复指腹缺损的临床效果。方法56例（56指）指腹缺损,应用邻指指动脉顺行岛状皮瓣修复拇指指腹4指,指动脉逆行岛状皮瓣修复2～5指指腹25指,带指神经血管蒂的岛状推进皮瓣修复2～4指指腹15指,指动脉背侧支逆行岛状皮瓣修复2～4指指腹6指,吻合血管的指动脉顺行岛状皮瓣修复示指指腹合并血管神经缺损2指,邻指带皮蒂的指动脉逆行岛状皮瓣中指指腹4指。皮瓣切取面积为1.5 cm×2.0 cm～3.0 cm×4.0 cm。结果56指皮瓣全部成活。随访1～2年,指腹外形满意,感觉恢复良好,指腹感觉按中华医学会手外科学会上肢部分功能评定试用标准评定：33指恢复至S4,13指恢复至S3＋,7指恢复至S3,3指恢复至S2。结论灵活应用不同术式的指动脉岛状皮瓣修复指腹缺损,手术简便易行、安全、效果好。     

指端缺损的急诊岛状皮瓣修复

目的介绍8种指岛状皮瓣对指端缺损创面的修复,并探讨其相关手术适应证。方法应用指神经血管束VY岛状推进皮瓣、拇指尺背侧动脉逆行皮瓣、指动脉背侧支逆行皮瓣、改良Moberg皮瓣、指动脉逆行皮瓣、Hueston皮瓣、指筋膜脂肪翻转瓣、指总神经血管束蒂双翼皮瓣等8种皮瓣修复79例82指指端缺损。结果手指外形和功能均取得了令人满意的结果。结论这些指岛状皮瓣适宜指端缺损的修复。     

Resurfacing the degloved thumb up to the interphalangeal joint level with twin extended neurovascular island flaps

We report a method of resurfacing the degloved thumb from the base of the thumb up to the interphalangeal joint level using two neurovascular island flaps from the adjacent sides of the long and the ring fingers, nourished by the third common neurovascular pedicle. This twin flap was used successfully in seven patients. The reconstruction gave adequate static two-point discrimination of 10mm at 6 weeks without complaints of neuroma pain, painful scars or cold intolerance.     

背甲皮瓣移植联合带指神经血管蒂岛状皮瓣移位再造拇指

目的探索拇指再造的新术式。方法采用吻合血管的背甲皮瓣移植联合带指神经血管蒂的岛状皮瓣移位,急诊延迟再造拇指。根据拇指残端情况,可选用中指尺侧或环指桡侧的岛状皮瓣。结果再造拇指３例全部成活,外形与功能恢复均良好。结论为急诊延迟再造拇指提供一种新方法,适用于拇指皮肤脱套伤及Ⅱ、Ⅲ度截指。     

The first dorsal metacarpal artery neurovascular island flap

A first dorsal metacarpal artery island flap from the index finger was used in 20 cases for reconstruction of defects in the hand. In six cases it was used as a neurovascular flap for sensory resurfacing of the thumb and in five cases for release of a contracted first web. One flap underwent necrosis and there was a complication in one donor site.     

以第一、二掌背动脉为蒂的岛状皮瓣修复拇指套脱伤

目的介绍应用以第一、二掌背动脉为蒂的岛状皮瓣修复拇指套脱伤的临床疗效。方法选择9例拇指套脱伤而指血管神经束、甲根、甲床完好或可修复的患者，采用以第一、二掌背动脉为蒂的手背桡侧岛状皮瓣转移修复拇指。结果术后9例皮瓣及供区植皮全部存活。术后7例获得6个月-4年的随访，2例失访。修复后的拇指及指甲外形、供区皮肤外形均较满意，指甲生长正常，拇指对指功能正常。皮瓣两点分辨觉为6．9mm，平均8mm。结论对拇指套脱伤指血管神经束存在，甲根、甲床尚好或可以修复的患者，采用以第一、二掌背动脉为蒂的手背桡侧岛状皮瓣修复是一种疗效较好的手术选择。     

Neurovascular free foot flaps in reconstruction of the mutilated hand.

The neurovascular free flap from the first web region of the foot affords unrivalled potential for refurbishing sensibility to the denervated hand. Its greatest application is when no conventional island flap tissue remains for transfer. Its two-point discrimination is only moderate, but when used for thumb reconstruction, its sensibility is adequate because no functional substitute exists. Functionally and cosmetically it is superior to other methods of thumb reconstruction because of its pulp, size, and nail availability. There are no finger identification problems and secondary donor defects are minimal.     

The Neurovascular Island Pedicle Flap

Nine patients with irreparable damage to the nerves of the thumb, treated with a neurovascular island pedicle flap from the third or fourth finger to the defect thumb, have been re-examined 9 months to 8 years after the operation.

Eight patients had a 2-point discrimination of less than 15 mm corresponding to the flap and all had a positive Ninhydrin test. Two had complete cortical reorientation and three partial reorientation. Six found the function of the thumb to be good or fair. Three described the result as poor and three had to be reoperated because of contractures of the donor finger and/or thumb.

The method can be recommended for use in young, well motivated patients.     

Neurokutaner Insellappen nach Foucher

INTRODUCTION: The "Foucher" flap is a pedicled neurovascular island flap of the first dorsal metacarpal artery. METHODS: From 1992 to 2000, thirty-three neurocutaneous island flaps from the dorsal aspect of the index finger (FDMCA flap) were performed for defect coverage and reconstruction of sensibility in the thumb. RESULTS: Static 2-PD over the flap area averaged 10.8 mm (range 4-15), compared to 8.2 mm (4-15) over the dorsal aspect of the contralateral index finger. Response to the SW monofilaments showed no difference to normal skin or only diminished light touch in 76% (19/25) patients. Seventy-six percent (19/25) were able to return to their previous jobs or resume previous activities. CONCLUSION: Based on negligible donor site morbidity of the flap and the good sensate quality and aesthetic appearance, the Foucher flap has become our first choice in defect coverage and restoration of sensibility of the thumb.     

The neurovascular island pedicle flap.

Nine patients with irreparable damage to the nerves of the thumb, treated with a neurovascular island pedicle flap from the third or fourth finger to the defect thumb, have been re-examined 9 months to 8 years after the operation. Eight patients had a 2-point discrimination of less than 15 mm corresponding to the flap and all had a positive Ninhydrin test. Two had complete cortical reorientation and three partial reorientation. Six found the function of the thumb to be good or fair. Three described the result as poor and three had to be reoperated because of contractures of the donor finger and/or thumb. The method can be recommended for use in young, well motivated patients.     

Sensory function of the neurovascular island flap in thumb reconstruction: comparison of original and modified procedures

A study was conducted to examine the sensory function of thumbs that were reconstructed using 2 procedures: the original Littler neurovascular island flap (NVIF) procedure and a modification of the NVIF procedure in which the divided nerve of the transferred island flap is sutured to the original nerve of the thumb. Twenty-one patients with a mean follow-up period of 4.6 years were examined. Nine patients were treated with the NVIF procedure and 12 with the modified NVIF procedure. Paresthesia was observed more frequently in the patients treated with the original NVIF procedure. The Semmes-Weinstein test and the static and moving 2-point discrimination examinations showed no significant difference between the 2 groups. The pulp writing test showed significantly better results for the patients treated with the modified NVIF procedure. The transferred pedicle flap was fully recognized as representing the thumb in the modified procedure. In the original procedure, however, the sensibility of the transferred pedicle flap was recognized as coming from the thumb in only 61% of the cases; furthermore, the original procedure carried an additional disadvantage in that sensibility of the transferred pedicle flap was recognized as coming from both the donor and recipient sites.     

Further experience with the bipedicled neurovascular island flap in thumb reconstruction

A procedure is described for the transfer of sensibility to the thumb by means of an island flap. The donor site is the dorsoradial surface of the index finger. The flap is supplied by two neurovascular pedicles. The palmar one includes the digital artery of the index and the dorsal branch of the palmar digital nerve. The dorsal pedicle includes the dorsoradial artery and nerve of the index and one or two superficial veins. This procedure was used in 29 patients without early postoperative complications. The advantages of the method are the resurfacing of the prehensile surface of the thumb by a flap with good arterial and venous supply while preserving the innervation and the palmar skin of the donor finger.     

同指顺行岛状皮瓣移位修复指腹缺损

目的探讨同指带指神经血管蒂顺行岛状皮瓣移位修复指腹缺损的手术效果。方法2003年11月~2005年2月,30例32指指腹缺损患者,男25例,女5例。年龄18~56岁。创面经彻底清创,应用抗生素治疗2~8d后行同指带指神经血管蒂顺行岛状皮瓣移位修复。缺损范围为1.5cm×1.2cm~3.5cm×2.1cm。皮瓣设计在同指的尺背侧或桡背侧,皮瓣远端距甲根不<5mm,避免损伤甲基质,近端不超过中节指横纹,腹侧切口不超过手指中线,背侧切口不超过手指背中线。切取皮瓣范围为2.0cm×1.5cm~4.0cm×2.5cm。供区创面切取上臂内侧带真皮下血管网皮片植皮。结果术后30例32个皮瓣全部成活,未发生血管危象。25例获随访2~8个月。皮瓣质地血运良好,外形满意,两点辨别觉7~10mm,手指伸展、屈曲活动功能基本正常。结论同指带指神经血管蒂顺行背侧方岛状皮瓣移位,手术方法简便、安全,效果满意,是修复拇、手指指腹缺损的一种较好方法。     

急诊修复拇指指腹缺损三种方法的研究

目的 报道采用不同方法急诊修复拇指指腹缺损的疗效。方法 采用示指背侧岛状皮瓣，拇指桡侧指动脉逆行岛状皮瓣转位有趾腹皮瓣游离移植三种方法，为21例线指指腹缺损进行急诊修复。结果 20例以瓣成活，1例失败。术后随访半年－2年，平均10个月。所有皮瓣血运，弹性，质地均良好。指腹二点分辨觉：示指背侧岛状皮瓣平均为92.mm，拇指桡侧动脉逆行岛状皮瓣平均为8mm，趾腹皮瓣平均为5.6mm。结论 急诊修复拇指指腹缺损首选趾腹皮瓣，其次为拇指桡侧指动脉逆行岛状皮瓣或示指背侧岛状皮瓣。     

前臂及拇背侧皮神经营养血管蒂岛状皮瓣的临床应用

目的探讨前臂及拇背侧带皮神经营养血管蒂岛状皮瓣临床应用的适应证。方法利用以前臂外侧皮神经营养血管为蒂的岛状皮瓣修复拇指末节脱套伤2例,带拇背桡侧皮神经营养血管蒂岛状皮瓣及尺背侧皮神经营养血管蒂逆行岛状皮瓣修复拇指掌侧软组织缺损10例。皮瓣切取面积2cm×3cm～7cm×11cm。结果11例皮瓣全部成活,1例前臂外侧皮神经皮瓣因切取面积较大导致远端部分坏死。结论以前臂皮神经营养血管为蒂的岛状皮瓣适用于拇指末节脱套伤,但皮瓣长度不应超过11cm;拇背侧皮瓣宽度较小,仅适宜修复拇指较小面积的软组织缺损。