| Purpose:The experimental was designed to observe the clinical anatomic characteristics, such as starting point and end, directions, numbers, diameters of vessels, the supply area and the intercommunications, of perforator digital artery and veins run accompanying it. To reveal the starting point, supply and drainage areas, as well as directions of perforator digital artery and veins run accompanying it, and the diameters of them, as well as locations and shapes of venous valves, to reveal the drainage of superficial and accompanying vein of digital artery, to provide an anatomic basis for choosing vessels to free perforator flaps. In clinic, we design operation plans using pedicle and free perforator digital artery flaps, investigate the methods of microvascular anastomsis, summarize the operation experiences, and observe the results of repairment of digital defects by perforator artery flaps. To provide the basis of application of perforator digital artery flaps, selection of accomplying veins and treatment of vessel crisis after operation.Method:10hand specimens harvested from fresh adult cadavers were perfused with red nature emulsion, and then observed under microscope. The starting point and end, directions, numbers, diameters of vessels, the supply area and the intercommunications, of perforator digital artery and veins run accompanying it, as well as the location of perforator digital artery and the digital nerve were recorded. Superficial vein of10fresh hand specimens was exposed, perfused with methylene blue, observing the direction, diameter, intercommunications, as well as venous valves, summarize the drainage of digital artery accompanying veins and superficial veins.In clinic, digital defects were repaired using perforator digital artery flaps, which were designed the appropriate size and shape of the flap nourished with the perforator branches of digital artery at the proximal phalanx according to the fingertip defect. Use the superficial vein at the edge of flap as reflux vessels; use the palmer perforator branch of proper digital nerve or the perforator branch of the dorsal branch of proper digital nerve as the sensory nerve. Find the perforator branches of digital artery to the flap, beginning is cut off and forming a branch artery pedicle flap. The fingertip reconstructed with the free flap. The perforator branches of the digital artery in the flap and the distal branch or trunk of the digital artery anastomosis, repair the flap nerve and the nerve stump, flap veins and superficial venous anastomosis. All patients were follow-up as long as6months.Results:The perforator branches were abundant in the palmaris. There are4branches in each section, the intervals was1mm, and diameter was0.50±0.21mm supply from central to lateral of the digital. Digital artery gives4branches to the dorsal of digital; they are condyle branches, Stem epiphyseal branches, dorsal perforator branches and the transverse palmar arch. There are4branches in the dorsal digital. The1st branch was given off in the distal of proximal phalanx, runs oblique dorsally to the interphalangeal joint. The2ed branch was given off in the basal of the middle phalanx, runs dorsally and oblique to the skin. The3rd branch was given off in the distal of the middle phalanx, runs to the skin of distal interphalangeal joint. The last one was given off in the basal of distal phalanx, runs to the skin of the nail root. The accompanying veins of both digital artery and branches were exist, and no defect was found. The accompanying vein was aroused from the vein plexus under dermis. Subcutaneous tissue and deep fascia layer were formed when the vein runs through it. The perforator branches of the digital artery can be classified to3types.1. The lateral type, which means artery runs laterally to the digital nerve, and often in the proximal part.2. The equilibration, there are equal of each side.3.the medial type, there are more branches in the medial of the digital nerve than in the lateral. In the distal section, the branches runs medial to form the arch, are all medial type.There are abundant communicating branches between superficial and profound veins. Most of digital artery and perforator vessels run in the type of accompanying with veins, which is drainage of local flaps, as well as free flaps. The diameters of accompanying vein of perforator digital artery are0.2mm. There are communicating branches between accompanying veins, superficial and profound veins. And there is no valve in the accompanying vein.Conclusions:1. The palmaris perforator branches, which are constant in location and large in diameter, were abundant. The dorsal perforator branchs, which are constant in location, run long distance and supply large areas. The perforator branches can be used as pedicle for flaps, which is employed for repairment of digital defects. The accompanying vein should be protected in ther surgery. The perforator digital artery runs in a constant pattern, which distributed in a spatial formula pattern from palmaris to dorsal side. The communicating branches form vessel chain structure, which can be used as pedicle for flaps in clinic.2The accompanying veins are communicated in a ladder type, then, if there are injuries of one side, the total drainage is not affected. The accompanying vein origins from venous plexus of sub dermis, reflux to the superficial vein, forming communications between superficial and profound veins, the accompanying veins can be used as part or whole drainage.3The accompanying veins of digital artery and perforator digital artery are objective existence. The diameters of the accompanying veins are0.2mm. the accompanying vein can be used as drainage for flaps.4. Free perforator digital artery flaps, supplied by independent perforator digital artery, bring no hurt to main arteries and employing superficial veins and accompanying veins as drainage. The application of the free perforator digital artery flaps in clinic is the trend of development of super microsurgery. |
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