Replantation of the complex amputated digital by using the flow-through flap based on the radial artery superficial palmar branch from palmar wrist area
Zheng Dawei*, Li Zhangcan, Cao Guangchao, Wu Yao, Shi Rongjian, Shou Kuishui.
Department of Hand and Foot Microsurgery, Xuzhou Renci Hospital, Xuzhou 221000, China
Abstract：Objective To investigate the application Methods and clinical outcomes of using the flow-through flap based on radial artery superficial palmar branch from palmar wrist area to replant complex amputated digital.Methods The clinical data of 11 patients with complex amputated fingers treated in the Hand and Foot Microsurgery Department of Xuzhou Renci Hospital from January 2012 to February 2015 were analyzed retrospectively. There were 7 males and 4 females, aged from 18 to 41 years, with an average age of 29.5 years. All the blood vessels in the affected fingers were interrupted. The extent of skin soft tissue defect ranged from 1.5 cm ×2.5 cm to 3.0 cm×6.0 cm, and the length of digital artery defect ranged from 1 to 3.5 cm. The flow-through flaps based on the superficial palmar branch of the radial artery from the wrist were used to replant the amputated fingers. The survival condition of the finger was observed. The function of the affected finger was assessed one year later, according to the standard of functional evaluation of finger replantation in Chinese Medical Association.Results In 11 cases, 10 cases completed the operation successfully. Because of the radial artery palmar superficial variation, 1 case was diverted to use venous flap to complete the operation. The flaps and fingers of the 10 patients survived successfully. The wounds and the donor sites were healed by first intention. All the patients were followed up from 12 to 18 months (average 15.5 months).The color and texture of the flaps were similar to those of the surrounding skin at the last follow-up. There was no scar in the donor site, and the wrist function was normal. The digitals function was assessed 1 year post-operation, excellent in 8 cases, good in 1 case, fair in 1 case.Conclusions The vascular pedicle is well matched with the digital artery. The flow-through flap based on radial artery superficial palmar branch from palmar wrist area is suitable for the complex amputated digitals replantation.
郑大伟, 黎章灿, 曹广超, 吴尧, 石荣剑, 寿奎水. 桡动脉掌浅支血流桥接皮瓣在复杂性断指再植中的应用[J]. 中华解剖与临床杂志, 2017, 22(4): 290-293.
Zheng Dawei, Li Zhangcan, Cao Guangchao, Wu Yao, Shi Rongjian, Shou Kuishui.. Replantation of the complex amputated digital by using the flow-through flap based on the radial artery superficial palmar branch from palmar wrist area. Chinese Journal of Anatomy and Clinics, 2017, 22(4): 290-293.
Neinstein RM, Dvali LT, Le S, et al. Complete digital amputations undergoing replantation surgery: a 10-year retrospective study[J]. Hand (N Y), 2012, 7(3): 263-266. DOI:10.1007/s11552-012-9427-z.
Zheng DW, Li ZC, Shi RJ, et al. Thumb reconstruction via a pedicled flap based on the superficial palmar branch of the radial artery from the wrist crease area[J]. J Plast Reconstr Aesthet Surg, 2015, 68(11): 1581-1587. DOI:10.1016/j.bjps.2015.07.003.
Olave E, Prates JC, Gabrielli C, et al. Abnormal course of the superficial palmar branch of the radial artery[J]. Surg Radiol Anat, 1996, 18(2): 151-153. DOI:10.1007/bf01795239.
[15]
Kamei K, Ide Y, Kimura T. A new free thenar flap[J]. Plast Reconstr Surg, 1993, 92(7): 1380-1384.
[16]
Cheung JW, Shyu JF, Teng CC, et al. The anatomical variations of the palmar cutaneous branch of the median nerve in Chinese adults[J]. J Chin Med Assoc, 2004, 67(1): 27-31.
[17]
Beldner S, Zlotolow DA, Melone CP Jr, et al. Anatomy of the lateral antebrachial cutaneous and superficial radial nerves in the forearm: a cadaveric and clinical study[J]. J Hand Surg Am, 2005, 30(6): 1226-1230. DOI:10.1016/j.jhsa.2005.07.004.
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