Effects of the first dorsal metatarsal artery terminal branch flaps in repairing skin and soft tissue defects of fingers

Wu Haibo; Jin Guangzhe; Li Jin; Zhang Yan; Wang Kai; Wang Qiang; Tang Xiaoqiang; Ju Jihui; Hou Ruixing

doi:10.3760/cma.j.cn501225-20231226-00271

Volume 40 Issue 10

Oct. 2024

Turn off MathJax

Article Contents

Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2024 > 40(10): 963-970

Wu HB,Jin GZ,Li J,et al.Effects of the first dorsal metatarsal artery terminal branch flaps in repairing skin and soft tissue defects of fingers[J].Chin J Burns Wounds,2024,40(10):963-970.DOI: 10.3760/cma.j.cn501225-20231226-00271.

Citation:

PDF( 18140 KB)

Effects of the first dorsal metatarsal artery terminal branch flaps in repairing skin and soft tissue defects of fingers

doi: 10.3760/cma.j.cn501225-20231226-00271

Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China

Funds:

Suzhou Key Medical Discipline SZXK202127

Science and Technology Planning Project of Wuzhong District WZYW2022008

More Information

Corresponding author: Jin Guangzhe, Email: jgz2000@sina.com
Received Date: 2023-12-26

Abstract

Abstract

Objective To explore the effects of the first dorsal metatarsal artery terminal branch flaps in repairing skin and soft tissue defects of fingers. Methods The study was a retrospective observational study. From October 2021 to December 2022, 44 patients with skin and soft tissue defects in 55 fingers who met the inclusion criteria were admitted to Suzhou Ruihua Orthopedic Hospital. There were 39 males (48 fingers) and 5 females (7 fingers), aged 18 to 54 years. The single wound area after debridement ranged from 1.5 cm×1.0 cm to 3.0 cm×2.0 cm. The color Doppler ultrasonography was performed before operation to locate the first dorsal metatarsal artery and its terminal branches, and a first dorsal metatarsal artery terminal branch flap was designed according to the wound condition, with the area of harvested single flap ranged from 1.7 cm×1.2 cm to 3.2 cm×2.2 cm. The wounds in the flap donor areas were transplanted with full-thickness skin grafts from ipsilateral inner calf. The type of flap was recorded, and the diameter of the terminal branch of the first dorsal metatarsal artery was measured during operation. The survival of the flap was observed one week after operation. The wound healing in the flap donor and recipient areas was observed two weeks after operation. At the last follow-up, the functional recovery of the affected fingers was evaluated by the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association, the sensory function of the flap was evaluated using the sensory function evaluation standard of British Medical Research Council, the scar in the donor and recipient areas of the flap was evaluated using the Vancouver scar scale (VSS), and the Allen test was conducted in the toe of flap donor area to evaluate the blood flow. Results The monoblock type flaps in 31 patients and flow-through type flaps in 2 patients were used to repair wounds in single finger, 2 monoblock type flaps in 8 patients were used to repair wounds in 2 fingers at the same time, and the single-pedicle and two-flap type flaps in 3 patients were used to repair wounds in 2 fingers at the same time. The diameter of the fibular terminal branch of the first dorsal metatarsal artery ranged from 0.40 to 1.10 mm, and the diameter of the tibial terminal branch of the first dorsal metatarsal artery ranged from 0.70 to 0.75 mm. All the flaps survived at one week after operation, and all the wounds demonstrated optimal healing in the flap donor and recipient areas at two weeks after operation. All patients were followed up for 6 to 18 months. At the last follow-up, the functional recovery of 48 fingers was evaluated as excellent, and the functional recovery of 7 fingers was evaluated as good; the sensory function of 8 flaps was rated as S2, and the sensory function of 47 flaps was rated as S3, and the two-point discrimination distance of the flaps was 8-14 mm; the VSS scores in the flap recipient areas ranged from 3 to 6, and the VSS scores in the flap donor areas ranged from 4 to 7; the Allen test result of the toes in the donor areas were all negative with normal blood flow. Conclusions The first dorsal metatarsal artery terminal branch flaps have several advantages, including relatively hidden donor area, shallow anatomical level, simple intraoperative operation, and flexible flap design. The flap is incised without damaging the main artery of the toe, which can repair skin and soft tissue defects of the fingers and ensure the utmost protection of the toes in donor areas. The fingers exhibit improved appearance, texture, sensation, and function after operation.
- Microsurgery,
- Surgical flaps,
- Finger injuries,
- Toes,
- Wound repair

FullText(HTML)

References(33)

References

[1]	武海波,金光哲,李锦,等.应用各种皮瓣修复手指皮肤软组织缺损[J].实用手外科杂志,2023,37(4):557-560.DOI: 10.3969/j.issn.1671-2722.2023.04.028.
[2]	马志强,谌晓强,刘军国,等.带一侧指掌侧固有动脉的侧方V-Y推进皮瓣修复指端缺损27例[J].中华显微外科杂志,2022,45(5):498-503.DOI: 10.3760/cma.j.cn441206-20220416-00075.
[3]	陈京国,仇申强,朱明昇,等.指背多级推进皮瓣的解剖学研究[J].中国临床解剖学杂志,2022,40(2):121-125.DOI: 10.13418/j.issn.1001-165x.2022.2.01.
[4]	李海,肖顺娥,邓呈亮,等.不同类型游离穿支皮瓣组合在四肢复杂创面修复中的临床应用[J].中华烧伤与创面修复杂志,2023,39(8):758-764.DOI: 10.3760/cma.j.cn501225-20220720-00300.
[5]	向胜涛,赵玲珑,郑文,等.改良掌背动脉皮瓣修复手指皮肤软组织缺损[J].实用手外科杂志,2021,35(3):305-308.DOI: 10.3969/j.issn.1671-2722.2021.03.010.
[6]	黄悦,林枫,郝春雨,等.改形设计指固有动脉岛状皮瓣修复复杂指端缺损的疗效[J].中华烧伤与创面修复杂志,2023,39(10):947-952.DOI: 10.3760/cma.j.cn501225-20230109-00008.
[7]	王凯,金光哲,滕志成,等.游离血流与神经桥接型第2趾胫侧皮瓣治疗近指间关节重度屈曲挛缩的效果[J].中华烧伤与创面修复杂志,2023,39(8):765-770.DOI: 10.3760/cma.j.cn501225-20220707-00286.
[8]	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(3):130. DOI: 10.3760/cma.j.issn.1005-054X.2000.03.003.
[9]	NikiH,AokiH,InokuchiS,et al.Development and reliability of a standard rating system for outcome measurement of foot and ankle disorders I: development of standard rating system[J].J Orthop Sci,2005,10(5):457-465.DOI: 10.1007/s00776-005-0936-2.
[10]	BaryzaMJ,BaryzaGA.The Vancouver scar scale: an administration tool and its interrater reliability[J].J Burn Care Rehabil,1995,16(5):535-538.DOI: 10.1097/00004630-199509000-00013.
[11]	吕云亮,齐英涛,杨磊,等. 双侧带血管神经蒂V-Y皮瓣修复手指末节指腹“V”形缺损1例[J]. 中华显微外科杂志,2024,47(3):347-349. DOI: 10.3760/cma.j.cn441206-20240220-00051.
[12]	印飞,顾珺,王军,等.递进皮下蒂双V-Y皮瓣联合髂骨植骨治疗小儿手指外伤术后钩甲畸形[J].中华手外科杂志,2024,40(2):166-169.DOI: 10.3760/cma.j.cn311653-20230602-00115.
[13]	侯桥,富红梅,任国华,等.单皮下蒂V-Y推进皮瓣联合蒂部植皮修复指端软组织缺损[J].中华显微外科杂志,2022,45(2):171-174.DOI: 10.3760/cma.j.cn441206-20211215-00295.
[14]	陈垒垒,王诒焓,郭松雪,等.腹部带蒂超薄皮瓣一期分指修复多指复合组织缺损[J].实用手外科杂志,2022,36(1):77-79.DOI: 10.3969/j.issn.1671-2722.2022.01.022.
[15]	刘刚义,谢瑞菊,苟军全,等.邻指皮瓣移植修复难以再植的拇指末节离断伤[J].中华显微外科杂志,2019,42(5):499-501.DOI: 10.3760/cma.j.issn.1001-2036.2019.05.021.
[16]	王辉,杨晓溪,刘冰冰,等.手部三种近位带蒂皮瓣接力修复手指指端脱套伤及供区软组织缺损的效果[J].中华烧伤杂志,2021,37(1):64-69.DOI: 10.3760/cma.j.cn501120-20200103-00001.
[17]	王道明,张松林,洪朝全,等.改良指固有动脉逆行岛状皮瓣的临床应用[J].实用手外科杂志,2021,35(3):296-297.DOI: 10.3969/j.issn.1671-2722.2021.03.007.
[18]	邹时雨,王克列,黄子荣,等.足趾侧方皮瓣修复指腹缺损的临床应用及研究进展[J].中华显微外科杂志,2024,47(2):235-240.DOI: 10.3760/cma.j.cn441206-20231204-00096.
[19]	陈鑫,梅俊霞,杨坤,等. 游离双足𧿹趾腓侧皮瓣修复相邻双指指腹缺损7例 [J]. 中华显微外科杂志,2024,47(1):39-43.DOI: 10.3760/cma.j.cn441206-20230828-00026.
[20]	周福成,周世义,何智阔,等.足趾侧方Flow-through皮瓣修复伴指端血运障碍的手指软组织缺损[J].中华手外科杂志,2024,40(1):29-31.DOI: 10.3760/cma.j.cn311653-20230112-00009.
[21]	周健,魏在荣,孙广峰,等.游离第3足趾胫侧微型皮瓣修复手指末节指腹皮肤软组织缺损[J].中华烧伤杂志,2019,35(3):205-208.DOI: 10.3760/cma.j.issn.1009-2587.2019.03.008.
[22]	李锦,武海波,金光哲,等.第2趾胫侧趾背动脉皮瓣与第2趾胫侧趾底固有动脉皮瓣修复手指皮肤软组织缺损疗效的对比研究[J].中华烧伤与创面修复杂志,2022,38(10):937-943.DOI: 10.3760/cma.j.cn501120-20210909-00310.
[23]	杨涛,陈佳,成贝贝,等.穿支皮瓣联合足趾移植术修复拇指毁损伴手部软组织缺损的临床疗效[J].中华烧伤杂志,2021,37(9):875-879.DOI: 10.3760/cma.j.cn501120-20200727-00360.
[24]	陈鑫,杨坤,宋振磊,等.游离第二趾胫侧皮瓣修复指腹缺损8例[J].中华手外科杂志,2024,40(1):20-22.DOI: 10.3760/cma.j.cn311653-20230510-00098.
[25]	钟怡鸣,孙焕伟,张洪权,等.改良游离第一趾蹼皮瓣移植修复手部指蹼皮肤缺损[J].中华手外科杂志,2019,35(2):122-124.DOI: 10.3760/cma.j.issn.1005-054X.2019.02.015.
[26]	董书男,黄东,江吉勇,等.拇指组合再造的应用解剖[J].中华手外科杂志,2020,36(5):376-379.DOI: 10.3760/cma.j.cn311653-20191212-00337.
[27]	张波,宫可同,尹路,等. 以第一跖背动脉为蒂的趾皮瓣与第二足趾组合移植再造手指缺损 [J]. 中华手外科杂志,2021,37(5):374-376. DOI: 10.3760/cma.j.cn311653-20201118-00376.
[28]	董书男,刘承伟,江吉勇,等.趾腓侧分叶穿支皮瓣拆分移植修复多发指端缺损[J].中华显微外科杂志,2024,47(1):44-47.DOI: 10.3760/cma.j.cn441206-20231102-00066.
[29]	王兵,马炬雷,张蛟,等.以趾背动脉为蒂的(拇)甲皮瓣修复拇指甲床合并指背皮肤缺损[J].中华手外科杂志,2019,35(6):470-471.DOI: 10.3760/cma.j.issn.1005-054X.2019.06.028.
[30]	GilbertA. Composite tissue transfer from the foot; anatomic basis and surgical technique[G]. St. Louis: Mosby, 1976:230-242.
[31]	徐磊,巨积辉,侯瑞兴,等.双足第二趾胫侧皮肤两点分辨觉的比较研究及其临床意义[J].中华手外科杂志,2016,32(6):460-462.DOI: 10.3760/cma.j.issn.1005-054X.2016.06.027.
[32]	蒋国栋,巨积辉,吕文涛,等.吻合趾背神经的第二足趾胫侧皮瓣修复指端缺损[J].中华整形外科杂志,2018,34(7):515-519.DOI: 10.3760/cma.j.issn.1009-4598.2018.07.005.
[33]	王晓松,巨积辉,吕文涛,等.带趾底固有神经和带趾背神经的第二趾胫侧皮瓣修复指端缺损的疗效对比[J].中华手外科杂志,2020,36(3):168-172.DOI: 10.3760/cma.j.cn311653-20191004-00277.