Repairing Finger Soft Tissue Defects With Using The Second Dorsal Metacarpal Flap And Compund Flap

Objective To application of the second dorsal metacarpal artery flapfor hand reconstruction.Methods From 2003 to 2006,12 SDMA flaps were transferred forhand injuries.Orthograde pedicled island SDMA flaps in 4cases(cutaneous in 4),retrograde pedicled island SDMA flaps in8cases(cutaneous in4 and teno—cutaneous in4).Results Of the 12 flaps,11 flaps survived completely,1survivedpartially.Follow—up was done in 11 cases for 6 to 10 months.Theflap had good texture and color match.The two point discriminationwas 5 to 9 mm in 6 sensate flaps,while it was 10 to 1 5 mm in4nonsensate flaps.In 4 tenocutaneous flaps,the TAM score of range ofmotion was 60% to 70% of the healthy side.Discussion There is 8% absence of SDMA according to the report, we needto try to find out the vascular length,courser and vascular caliber at the axleby Doppler ultrasound on preoperative .If there is variationg of bloodvessel,we must quit and change other operation. It's very important to protect2 accompanying vein with SDMA when we separated the vascular bundle,wecan remain as far as possible fascia superficialis and tunica muscularis.If youwant to avoid damaging the vascular bundle, it is not necessary to expose thevein. When the separation arrive the distal end of vascular bundle,we can'tdamage the cutaneous branches which getting into the flap's distal end. Thevascular bundle of SDMA is fairly slenderness,we must operate carefully andavoid excess drag. An area of flip ought to exceed an area of defect 10%-15%,furthermore ,it is no tension when we suture the flip. The cutaneous branchesof SDMA is to set out at it's distally 1/3,we must reserve more cutaneousburanches in the skin and the fascia consecutive with it, when we dissect thevessel. When we meet the blood vessel course in the interossei ,we needseparate it carefully from the muscle , reserve lamellar muscle oncircumference of blood vessel. When we cut tendon flap ,we should asdissect the paratenon as sew up the paratenon and subcutaneouslywith 3.0 line, in order to avoid to damage small cutaneousbranches.We ought to select the radial extensor muscle of indexfinger , reserve the ulnar extensor indicis proprius , for this reason ,we can not only ensure complex tissue flap has completemesotendine but also reserve the solo action of index finger.At thesame time , with the purpose of avoiding the porblem of dissociationdermatoplasty and scar contracture, adhesion of tendon , we as faras possible design the flap's diameter within 3.0cm.We can do my bestto carry out dialymeury , and we can avoid harmful cutaneous sensationrecovery after operation, moreover raise the two point discrimination of skin.However, there is hard question about to make use of simple antecedence skinflap to repair cutaneous deficiency of distally midplate. We must learnadvanced method from domestic and abroad. For instancd, developing freeflap transplantation ,it avoid the influence of blood vessel length andcyclodeviation arc of flap .It may arbitrarily repair each position of hand orfinger .The flap has the skin cut shorten , damage of subcutaneously tunneland blood vessel turn round decreased. There is only line shape scar afteroperation, and sensory function recovery fast after dialyneury. But there ismore risk and degree of difficulty about the operation ,because of theslenderness of the flap. Thus we must master expert technique of smallvascular anastomosis.Conclusion The second dorsal metacarpal artery island flaps for repairof hand architecture defects have its indication and clinical applicationvalue,and it is a reliable way for reconstruction of architecture defectsof hand.