Applied Anatomic Study Of The Digital Artery Dorsal Perforating Branches

Objective:To investigate the anatomical characteristics of the digital artery dorsal perforating branch flap and the feasibility of incision flap.Methods:Eight cases of adult cadaveric hands are injected with red latex via arterial cannula, dissection and observation the traveling, distribution,coincided relations and outer diameter of digital artery dorsal perforating branches, dorsal digital arteries, finger web artery and its perforating branches, metacarpea dorsalis artery and its perforating branches.Results:There are2to6artery dorsal perforating branches in side of the thumb proximal ulnar, mainly concentrated in the metacarpophalangeal joint, middle of proximal and near proximal. Each side of middle of proximal and near proximal has a relatively constant dorsal perforating branches.Thumb palm side of the radial artery and the dorsal branch of ulnar palm side artery formed a digital dorsal aortic arch in approximately0.7cm from the nail epithelium.Dorsal arterial arch and thumb ulnar dorsal artery configurated anastomosis. The anastomotic branch is issued by Thumb metacarpophalangeal joint connection with the thumb ulnar palmar artery. Thumb radial dorsal digital artery is issued by the branch of the radial artery in snuff fossa, which is smaller than the ulnar branch and limited to the thumb proximal radial dorsal. Thumb ulnar, radial side of the dorsal artery branch and the digital artery dorsal perforating branches mutual coincided to form a proximal knuckle dorsal dorsal arterial network.Each side of2to5middle segment of finger proximal have2to8digital artery dorsal perforating branches.1to7indirect dorsal cutaneous branch, the middle and distal of the proximal section, the proximal or middle of the middle section,all has one constant dorsal perforating branche. Both of their average diameter is greater than or equal to0.30mm,except the little finger in the middle of the near and middle section of the artery. The outer diameter is generally greater than or equal to0.20mm in the middle and far point of recent section, the near and middle point of the middle section.The digital artery dorsal perforating branches separated multiple upstream and downstream branches when come in the dorsal superficial fascia. These different segments of the upward and downward branches mutually copncided in the dorsal lateral border. The digital dorsal branches mutually consisted and trafficed with each other in the proximal finger dorsolateral edge. Which is issued by the section near the artery dorsal perforating branches, the dorsal metacarpal artery and distal deep palmar arch perforating branches. Then formated to a longitudinal nutrition vascular chain in the digital dorsolateral margin.The little finger ulnar artery is issued directly to the superficial palmar arch, radial side issued by the4th palmar artery. Small point dorsal artery ulnar support for continuity from terminal branches of the5th metacarpal ulnar dorsal artery(Dorsal branch of the wrist in the ulnar artery in the wrist at the origin),the small branch of its dorsal wear issued interaction consistent with the formation of the dorsal artery. Nearly collateral radial collateral for the deep palmar arch is consistent with the traffic branch of the dorsal carpal arterial network formed by4dorsal metacarpal artery terminal branch of the branch refers to the webbed area.Refers to the chain of copies in existence longitudinal dorsal artery in the little finger of the dorsal cutaneous branch and4th dorsal metacarpal artery refers to the dorsal branch of the little finger proximal anastomosis blood supply mode.Conclusion:Thumb radial and ulnar side existed2-6branches of artery dorsal perforating branche. Each side of middle of proximal and near proximal had a relatively constant dorsal perforating branches.In the metacarpophalangeal joints and proximal knuckle near the middle, the number of perforating branches in radial side and the outside diameter were larger than the ulnar.In the radial and ulnar side of2-5fingers,there were2-8branchs of artery perforating branches.Each of the middle and distal of the proximal knuckle, the proximal or middle of the middle phalanx presenced a constant dorsal perforating branch. Between the upstream and downstream branch of perforating branches,between the dorsal digital artery and dorsal metacarpal arteries there were directly connected or indirectly connected chain for blood supply.So the incision flap of the digital artery dorsal perforating branches have reliable blood supply, surgical flap survival, it is one of the ideal flap to repair a finger wound. Objective:To study the feasibility of the digital artery dorsal perforating branch flap to repair thumb and finger skin and soft tissue defect.Methods:28cases of thumb and finger wound patients use the digital artery dorsal perforating branch flap to repair the wound. There are20males and8females, aged from6to60years. The wound range about4.0cm×2.0cm to5.0cm×2.0cm, and the flap range about5.0cm×2.2cm to6.5cm×2.2cm. There have6cases of thumb trauma,8cases of the index finger trauma,6cases of the middle finger trauma,4cases of the ring finger trauma and4cases of the little finger trauma.The flap donor area skin graft coverage or direct suture.Results:The flap and skin graft survived successfully. The patients are followed up for7to18months, an average of12months. The fracture healed completely, the flap is in good shape. There are no dysfunction in flexion and extension, two-point discrimination among flap is8-9mm. Finger total active range of motion, assessed according to the Chinese Medical Association of Hand Surgery Society upper extremity part of the functional evaluation trial standards are excellent in28cases.Conclusion:Thumb ulnar can be cut distal pedicle thumb artery dorsal flap,proximal pedicle and thumb ulnar dorsal artery retrograde island flap, proximal pedicle and the jaws of death dorsal retrograde island flap. Radial side of the thumb can be cut proximal pedicle and the thumb radial dorsal flap. Index finger, middle finger, ring finger and little finger ulnar and radial can be cut distally digital artery dorsal perforating branch flap, and index finger, middle finger, ring finger and foot radial side of the little finger radial side of the proximal dorsal perforating branches of the pedicle palm back flap. The little finger ulnar can be cut proximal pedicle and the5th metacarpal foot dorsal artery retrograde island flap.