Email Alerts
RSS
Volume 39 Issue 11
Nov.  2023
Turn off MathJax
Article Contents
Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2023  >  39(11): 1038-1046
Wang H,Zhou T,Liu YJ,et al.Effects of four types of perforator flaps pedicled with cutaneous neurotrophic vessels in repairing wounds on the volar side of hands[J].Chin J Burns Wounds,2023,39(11):1038-1046.DOI: 10.3760/cma.j.cn501225-20230720-00009.
Citation: Wang H,Zhou T,Liu YJ,et al.Effects of four types of perforator flaps pedicled with cutaneous neurotrophic vessels in repairing wounds on the volar side of hands[J].Chin J Burns Wounds,2023,39(11):1038-1046.DOI: 10.3760/cma.j.cn501225-20230720-00009.
shu

Effects of four types of perforator flaps pedicled with cutaneous neurotrophic vessels in repairing wounds on the volar side of hands

doi: 10.3760/cma.j.cn501225-20230720-00009
  • 1.

    Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan 063000, China

  • 2.

    Functional Examination Department, the Second Hospital of Tangshan, Tangshan 063000, China

  • 3.

    College of Traditional Chinese Medicine, North China University of Science and Technology, Tangshan 063210, China

Funds:

Medical Science Research Plan Project of Hebei Province of China 20201453

Tracking Project of Medical Applicable Technology in Hebei Province of China GZ2021030

Science and Technology Plan Project of Tangshan City 22150219J

More Information
    Abstract
  •   Objective   To investigate the effects of four types of perforator flaps pedicled with cutaneous neurotrophic vessels in repairing wounds on the volar side of hands.   Methods   A retrospective observational study was conducted. From May 2012 to July 2021, 122 patients with wounds on the volar side of hands who met the inclusion criteria were admitted to the Department of Hand Surgery of the Second Hospital of Tangshan, including 74 males and 48 females, aged 18-76 years. There were 15 cases of palm injury alone, 101 cases of finger injury alone, and 6 cases of simultaneous palm and finger injury. The wounds with area ranging from 1.5 cm×1.2 cm to 15.0 cm×6.0 cm were all repaired by transplantation of perforator flaps pedicled with cutaneous neurotrophic vessels, including 16 cases of the ulnar artery perforator flap carrying the medial antebrachial cutaneous nerve, 20 cases of the dorsal metacarpal artery perforator flap carrying the dorsal metacarpal cutaneous nerve, 21 cases of the digital artery dorsal perforator flap of thumb carrying the terminal branch of lateral antebrachial cutaneous nerve, and 65 cases of the digital artery dorsal perforator flap of the 2 nd to 5 th finger carrying the dorsal branch of digital nerve, with the sizes of flaps ranging from 1.8 cm×1.4 cm to 20.0 cm×6.0 cm. High-frequency color Doppler ultrasonography was performed to locate and measure the perforators and cutaneous nerves of the flaps preoperatively. The cutaneous nerves carried by the flaps were all anastomosed with the nerves at the recipient sites during the operation. The donor sites were closed directly or repaired with split- or full-thickness free skin graft from the ipsilateral thigh or proximal medial forearm. The survival of the flaps and skin grafts at the flap donor sites, and the healing of incisions at the flap donor sites were observed postoperatively. The patients were followed up, and at the last follow-up, the static two-point discrimination distances of the flaps were measured, the degree of satisfaction of patients with the appearances of the flaps and flap donor sites were evaluated based on the evaluation criteria of Michigan Hand Function Questionnaire, and the functions of the affected hands were evaluated according to the trial criteria for upper limb function evaluation of the Hand Surgery Society of the Chinese Medical Association.   Results   After surgery, the distal end of the ulnar artery perforator flap carrying the medial antebrachial cutaneous nerve transplanted in one patient and the digital artery dorsal perforator flap of the 2 nd to 5 th finger carrying the dorsal branch of digital nerve transplanted in two patients were partially necrotic but healed after dressing change; the flaps transplanted in the other 119 patients all survived. All skin grafts at the flap donor sites survived, and all incisions at the flap donor sites healed after surgery. The follow-up period was 10 to 36 months, with an average of 16 months. At the last follow-up, the static two-point discrimination distances of the ulnar artery perforator flaps carrying the medial antebrachial cutaneous nerve was 10 to 20 mm. Ten patients were strongly satisfied and 6 patients were satisfied in the evaluation of satisfaction with the appearance of the flaps. Seven patients were strongly satisfied and 9 patients were satisfied in the evaluation of satisfaction with the appearance of the flap donor sites. Functional evaluation of the affected hand was excellent in 7 cases, good in 7 cases, and fair in 2 cases. For the dorsal metacarpal artery perforator flap carrying the dorsal metacarpal cutaneous nerve, the static two-point discrimination distances of the flaps was 8 to 18 mm; 13 patients were strongly satisfied and 7 patients were satisfied in the evaluation of satisfaction with the appearance of the flaps; 10 patients were strongly satisfied and 10 patients were satisfied in the evaluation of satisfaction with the appearance of the flap donor sites; the functional evaluation of the affected hand was excellent in 11 cases, good in 7 cases, and fair in 2 cases. For the digital artery dorsal perforator flap of thumb carrying the terminal branch of lateral antebrachial cutaneous nerve, the static two-point discrimination distances of the flaps was 6 to 11 mm; 17 patients were strongly satisfied and 4 patients were satisfied in the evaluation of satisfaction with the appearance of the flaps; 13 patients were strongly satisfied and 8 patients were satisfied in the evaluation of satisfaction with the appearance of the flap donor sites; the functional evaluation of the affected hand was excellent in 15 cases and good in 6 cases. For the digital artery dorsal perforator flap of the 2 nd to 5 th finger carrying the dorsal branch of digital nerve, the static two-point discrimination distances of the flaps was 5 to 12 mm; 43 patients were strongly satisfied and 22 patients were satisfied in the evaluation of satisfaction with the appearance of the flaps; 47 patients were strongly satisfied and 18 patients were satisfied in the evaluation of satisfaction with the appearance of the flap donor sites; the functional evaluation of the affected hands were excellent in 39 cases, good in 21 cases, and fair in 5 cases.   Conclusions   With the assistance of high-frequency color Doppler ultrasonography, four types of perforator flaps pedicled with cutaneous neurotropic vessels which are used to repair different types of wounds on the volar side of the hand can have reliable blood supply, are easy to cut, cause minimal secondary damage to the donor area, and have good recovery of the flap sensation after surgery.

     

    • FullText(HTML)
  • loading
    • References(27)
  • [1]
    GeorgescuAV,MateiIR.Propeller perforator flaps in forearm and hand reconstruction[J].Eur J Orthop Surg Traumatol,2019,29(2):357-366.DOI: 10.1007/s00590-018-2323-7.
    [2]
    ZeidermanMR,PuLLQ.Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma[J/OL].Burns Trauma,2021,9:tkab024[2023-07-20].https://pubmed.ncbi.nlm.nih.gov/34345630/.DOI: 10.1093/burnst/tkab024.
    [3]
    UsamiS,InamiK,HiraseY,et al.An ulnar parametacarpal perforator flap for volar digital soft tissue reconstruction[J].J Hand Surg Eur Vol,2020,45(8):842-848.DOI: 10.1177/1753193420939379.
    [4]
    KhoongYM,HuangX,GuS,et al.Imaging for thinned perforator flap harvest: current status and future perspectives[J/OL].Burns Trauma,2021,9:tkab042[2023-07-20].https://pubmed.ncbi.nlm.nih.gov/34926708/.DOI: 10.1093/burnst/tkab042.
    [5]
    HuangX,XuJ,YangH,et al.Reconstruction of thumb defects with medial sural artery perforator flap: case series[J].Ann Transl Med,2021,9(8):658.DOI: 10.21037/atm-21-526.
    [6]
    秦桂兰,尼玛德吉,王元胜,等.高原地区穿支皮瓣在手部软组织缺损中的应用[J].中华手外科杂志,2021,37(2):134-136.DOI: 10.3760/cma.j.cn311653-20200419-00178.
    [7]
    SafaB,LeeDC,ParkJ,et al.Reconstruction of digit soft tissue defects with the fourth common digital artery perforator flap[J].J Hand Surg Am,2022,47(11):1115.e1-1115.e7.DOI: 10.1016/j.jhsa.2021.08.016.
    [8]
    GuiottoM,di SummaPG,ArgentinoG,et al.The proximal ulnar perforator flap (PUPF) for hand digital reconstruction: an anatomical study[J].J Plast Surg Hand Surg,2021,55(4):255-259.DOI: 10.1080/2000656X.2021.1873793.
    [9]
    BordianuA,LeoveanuFI.Hand soft tissue reconstruction with dorsal metacarpal artery perforator (Quaba) flap[J].J Med Life,2021,14(5):731-736.DOI: 10.25122/jml-2021-0313.
    [10]
    ChangDH,HsiehCY,ChangCW,et al.Using dorsal metacarpal artery perforator flap in the soft tissue reconstruction of traumatic finger defects: a single-center study[J].Ann Plast Surg,2021,86(2S Suppl 1):S113-118.DOI: 10.1097/SAP.0000000000002656.
    [11]
    ShimboK,KawamotoH,KoshimaI.Finger reconstruction with distally based dorsal metacarpal flaps: a systematic review[J].Ann Plast Surg,2022,89(5):573-580.DOI: 10.1097/SAP.0000000000003208.
    [12]
    LinYT,LohCYY,LinCH.Flaps based on perforators of the digital artery[J].Hand Clin,2020,36(1):57-62.DOI: 10.1016/j.hcl.2019.08.007.
    [13]
    KhanWU,AppukuttanA,LohCYY.Homodigital pedicled digital artery perforator flaps for fingertip reconstruction - a review of flap options[J].JPRAS Open,2022,34:199-218.DOI: 10.1016/j.jpra.2022.09.004.
    [14]
    ChungKC,PillsburyMS,WaltersMR,et al.Reliability and validity testing of the Michigan Hand Outcomes Questionnaire[J].J Hand Surg Am,1998,23(4):575-587.DOI: 10.1016/S0363-5023(98)80042-7.
    [15]
    潘生德,顾玉东,侍德.中华医学会手外科学会上肢部分功能评定试用标准[J].中华手外科杂志,2000,16(3):130-135.DOI: 10.3760/cma.j.issn.1005-054X.2000.03.003.
    [16]
    KoshimaI,YamamotoT,NarushimaM,et al.Perforator flaps and supermicrosurgery[J].Clin Plast Surg,2010,37(4):683-689, vii-iii.DOI: 10.1016/j.cps.2010.06.009.
    [17]
    WangKL,ZhangZQ,BuckwalterJA,et al.Supermicrosurgery in fingertip defects-split tibial flap of the second toe to reconstruct multiple fingertip defects: a case report[J].World J Clin Cases,2019,7(17):2562-2566.DOI: 10.12998/wjcc.v7.i17.2562.
    [18]
    EscandónJM,CiudadP,MayerHF,et al.Free flap transfer with supermicrosurgical technique for soft tissue reconstruction: a systematic review and meta-analysis[J].Microsurgery,2023,43(2):171-184.DOI: 10.1002/micr.30894.
    [19]
    ZhengL,LvXM,ShiY,et al.Use of free flaps with supermicrosurgery for oncological reconstruction of the maxillofacial region[J].Int J Oral Maxillofac Surg,2023,52(4):423-429.DOI: 10.1016/j.ijom.2022.04.019.
    [20]
    徐永清,何晓清,陈雪松,等.手和足部创面修复时四种吻合血管的皮神经营养血管穿支皮瓣的选择[J].中华显微外科杂志,2020,43(4):331-337.DOI: 10.3760/cma.j.cn441206-20200218-00068.
    [21]
    HuD,HongX,WeiX,et al.Anatomical basis and clinical application of the first metatarsal proximal perforator-based neurocutaneous vascular flap[J].Clin Anat,2020,33(5):653-660.DOI: 10.1002/ca.23479.
    [22]
    张宇轩,许亚军,崔毅,等.三种不同形式的小腿内侧岛状皮瓣临床应用分析[J].中华显微外科杂志,2020,43(1):5-9.DOI: 10.3760/cma.j.issn.1001-2036.2020.01.003.
    [23]
    ZhouLL,WeiJW,PengP,et al.Distally based perforator-plus sural neurocutaneous flap with high or low pivot point: anatomical considerations and a retrospective study of a clinical series of 378 flaps[J].J Reconstr Microsurg,2021,37(7):580-588.DOI: 10.1055/s-0041-1723817.
    [24]
    SporerME,BertelliJA.Reverse neurocutaneous flap based on the dorsal branch of the ulnar artery for palm coverage in children: long-term results[J].J Hand Surg Am,2022,47(12):1192-1201.DOI: 10.1016/j.jhsa.2022.09.001.
    [25]
    王辉,杨晓溪,霍永鑫,等.前臂外侧皮神经终末支营养血管皮瓣修复拇指指端或指腹创面的临床效果[J].中华烧伤杂志,2021,37(8):758-763.DOI: 10.3760/cma.j.cn501120-20200607-00298.
    [26]
    王辉,杨晓溪,霍永鑫,等.双皮神经吻合局部带蒂皮瓣修复拇指缺损[J].中国矫形外科杂志,2022,30(18):1689-1692.DOI: 10.3977/j.issn.1005-8478.2022.18.12.
    [27]
    顾玉东.指部皮肤缺损的修复原则[J].中华手外科杂志,2012,28(3):130.DOI: 10.3760/cma.j.issn.1005-054X.2012.03.002.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(5)  / Tables(1)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (212) PDF downloads(15) Cited by()
    Proportional views
    Related

    Copyright © Chinese Journal of Burns京ICP备07035254号-14

    E-mail：shaoshangzazhi@163.com

    Website：https://zhsszz.xml-journal.net/

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return