| Background:Since the1980s, perforator flap get larger development, In recent years,the clinical application of literature about free posterior interosseous artery perforator flap had scattered reports at home and abroad, but the lack of systematic anatomy and clinical research, because of the posterior interosseous artery perforator and wrist communicating branch variation rate was higher, affected the clinical application of the flap.It was necessary for the systematic anatomy and research about microdissection and hemodynamic of the flap, design scientific, safe and practical operation methods, in order to reduce clinical complications, improve the survival rate and the clinical curative effect, promote its clinical application.Objectives:To experlor and statically analysis the perforators of the posterior interosseous artery (PIA),20forearms from10cadavers were dissected with microinstrument. The number of the perforator (inner-diameter>0.2mm) was counted and the distance from its musle point and into-skin point of the peforator of the PIA to lateral epicondyle of the humerus was measured on those forearms. The inner-diameter of each perforator and the perforator length were also measured.The relationship of accompanied veins and nerves to the PIA were analysed. Based on the data from cadaver anatomy, about40cases with soft tissue defect on fingers and hands were admited and be covered by the free perforator PIA flaps.Follow-up ranged from6mouths to1year or longer, recording the flaps survival, outlook and its sensation measured. Patient’s degree of statisfaction is also listed on follow-up table. Finally,based on the antamy study and the clinical application, we give our experience of free translation of the perforator PIA flap.Methods:20forearms from10cadavers were flooded by red latex through axillary artery, after which those forearms were anatomised layers by layers on dorsal aspect to expose the perforator of the PIA precisely.The data including how many perforators,the distance from musle point and into-skin point of the peforator of the PIA to lateral epicondyle of the humerus,the inner-diameter, the perforator length, the relationship with the posterior interosseous nerve were collected and analysed. Based on those data,40cases with soft tissue defect on hand were admitted and covered with the ipsilateral free PIA perforator flap under brachial plexus block from January2009to December2012. With clinical application on soft tissue defect,the characteristics of the perforator of the PIA were further analysed. Postoperative oberservation in1week mainly including the surviving and arteriovenous crisis with the principle of management. Patients were followed up on the lst,3rd,6th,12th month postoperatively referring complications on donor and recipient area, the outlook and the sensation of flaps and patients"satisfaction with the tranplations procedure and results.Results:There are2-5(averaged3±0.3) perforators each apart3.0-6.0cm diverged from PIA supplying the overlying soft tissue.The distance from mousle point to the into-skin point is0.8-2.7cm,while from musle point to the epidondyle is (11.2±4.8) cm. The inner-diameter of the originated perforator is (0.5±0.2)mm. There are over two effective perforators (inner-diameter≥0.5mm) found from3limbs.The most thick perforator is located on the point (9.6±3.2)cm from the lateral epicondyle of the humerus, the averaged length of each perforator is (2.7±0.3) cm, the inner-diameter of the originated perforator is (0.6±0.1)mm. Each perforator artery accomplishs two perforator veins. In clinic≥35cases were successfully survived, Bubbles and violet happened in5cases,after partial suture removal,3cases survived, and1case of partial necrosis,1case of complete necrosis. All of the patients were followed up3to24months, Flap color was similar to the district, no obvious bloated, flap donor site scar contracture was not obvious.Conclusions:There are several permanent perforators on the dorsal forearm area, branch numbers are available, and meet the design requirements, and the parts of the skin close to refer to the dorsal finger and hand skin texture, feasible single body anesthesia, easy to be accepted by patients. Free interosseous artery perforators flap after transplantation donor area is often direct suture, for the area looks good, feel functions are satisfactory. Therefore, for small and medium-sized area skin defect of the dorsal finger and hand, free forearm interosseous artery perforators flap is a good choice, it is worth clinical popularization and application. |
