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

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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.

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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

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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

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References

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