| Chapter one The anatomic study of the dorsal artery flap Section one Anatomy of the antisepticized specimensObjective:Through the investigation of 7 embalmed hand anatomical observation of dorsal metacarpal artery and its cutaneous anatomic features, including its origin, quantity, walking, traffic branch anastomosis and blood supply distribution range, for a variety of skin flap with dorsal metacarpal artery, based composite tissue flap transplantation for the repair of hand skin, soft tissue defect congenital syndactyly refers to provide anatomic basis for the reconstruction of web space.Methods:Take 7 embalmed hand dissection microscope, full exposure to dorsal metacarpal dorsal metacarpal artery, observation, measurement, its course, quantity, distribution, the data were analyzed statistically.Result:Dorsal metacarpal artery located in the back of the deep layer of superficial extensor tendon, walking in the dorsal interosseous muscle, a total of 4. The first dorsal metacarpal artery issued by the dorsal carpal branch of radial artery, a continuation of the index finger dorsal radial artery, the outer diameter of the end of the starting point of 0.69+0.05mm, outer diameter of 0.40+0.05mm,52.34+ 3.66mm, length of stroke. Second to 4 dorsal metacarpal artery issued by the proximal perforating branch of the deep palmar arch, and the dorsal carpal arterial network sends traffic anastomosis, go for in superficial dorsal interosseous muscle in the dorsal lateral distal finger web, continuing as the dorsal artery. The initial diameter were 0.81+0.08mm,0.65+0.09mm,0.54+0.06mm, respectively at the end of outer diameter was 0.61+0.06mm,0.49+0.11mm,0.41+0.06mm. Stroke were 55.70+4.20mm,52.20+6.27mm,52.75+5.12mm.Conclusion:the hand skin and 1 metacarpal dorsal skin from the 4 dorsal metacarpal artery nutrition. First to 4 dorsal metacarpal artery terminal branch continued to the dorsal artery. In the intercapital from cutaneous branches up. The net structure is formed between the metacarpal dorsal artery.Section two Anatomy of the fresh specimensObjective:Through the investigation of 9 fresh specimens of hand, using natural latex (red industrial fuel staining) artery perfusion, dissection and observation of dorsal metacarpal artery and its cutaneous branch of the starting and ending, quantity, walking, traffic branch anastomosis and blood supply distribution range, for a variety of skin flap with dorsal metacarpal artery, based composite tissue flap transplantation for the repair of hand skin, soft tissue defect, congenital syndactyly and provide anatomical basis.Methods:9 fresh hand specimens, natural latex (red industrial fuel stain), by ulnar artery, radial artery for vascular perfusion via the -30 DEG C, freezer 2 days, rewarming after thawing dorsal metacarpal artery system anatomy observation, measurement, the data were analyzed statistically.Result:Dorsal metacarpal artery located in the back of the deep layer of superficial extensor tendon, walking in the dorsal interosseous muscle, a total of 4, namely the first dorsal metacarpal artery, second dorsal metacarpal artery, third dorsal metacarpal artery, fourth dorsal metacarpal artery. The first dorsal metacarpal artery issued by the dorsal carpal branch of radial artery, a continuation of the index finger dorsal radial artery, the outer diameter of the end of the starting point of 0.68+ 0.05mm, outer diameter of 0.41+0.05mm,53.34+3.66mm, length of stroke. Second to 4 dorsal metacarpal artery issued by the proximal perforating branch of the deep palmar arch, and the dorsal carpal arterial network sends traffic anastomosis, go for in superficial dorsal interosseous muscle in the dorsal lateral distal finger web, continuing as the dorsal artery. The initial diameter were 0.82+0.08mm,0.67+ 0.09mm,0.54+0.06mm, respectively at the end of outer diameter was 0.61+ 0.06mm,0.49+0.11mm,0.41+0.06mm. Stroke were 55.70+4.20mm,54.20+ 6.27mm,52.75+5.12mm.Conclusions:The dorsum of the hand skin and 1 metacarpal dorsal skin from the 4 dorsal metacarpal artery nutrition. First to 4 dorsal metacarpal artery terminal branch continued to the dorsal artery. In the intercapital from cutaneous branches up. The net structure is formed between the metacarpal dorsal artery.Chapter two The clinical application of the dorsal artery flap Section one Application of the dorsal metacarpal flap in hand soft tissue and skin defectObjective:To explore the application of pedicled with dorsal metacarpal artery as flap in repairing skin defects of the hand and clinical effect. Patients with soft tissue defect in the hand as the research object, according to the course, distribution of dorsal metacarpal artery design, cut a variety of dorsal metacarpal artery flap, repair of hand soft tissue defect, and followed up patients after operation effect, provides a theoretical support and a variety of clinical verification effectively repair method for the repair of type micro surgery and hand surgery clinical repair of hand soft tissue defect.Methods:in 2012 May to 2013 November, by the application of dorsal metacarpal artery of 16 patients with hand perforator flap for repair of soft tissue defect of pedicle.Results:16 patients with dorsal metacarpal artery perforator flap repair of hand soft tissue defect removal of pedicle,2 cases of flap survival is poor, the rest of the flaps survived, followed up for 5 months to 23 months, average 13.3 months follow-up, patients with up to 95.6% of the flap function and appearance satisfaction. The survival of skin flap of skin temperature without exception, color and normal skin is the skin elasticity, skin flap, no pigmentation, no abnormal appearance. Anterograde dorsal metacarpal artery island flap of dorsal metacarpal cutaneous nerves without damage, the two-point discrimination was 7.3 (6～9) mm; anastomosis after sensory nerve retrograde dorsal metacarpal artery island flap for 2～ 4 months sensory recovery, and two-point discrimination was 9.6 (8～13) mm. The donor site scar contracture of skin necrosis, no complications such as donor site scar left, linear.Conclusion:the dorsal metacarpal artery and its cutaneous branch flap vascular chain, hand soft tissue repair and skin defect, flap area, postoperative donor site can be directly suture, reliable blood supply, flap survival rate is high, the feeling function recovery satisfaction, is one of the better method for treatment of hand soft tissue and skin skin defect.Section two The application of the dorsal metacarpal perforator flap sliding operation in web-space reconstruction of congenital syndactylyObjective:To investigate the dorsal perforator flap sliding operation in congenital syndactyly refers to the application in the reconstruction of web space. Postoperative follow-up records refer to hand movement and sensory function. Thus for microsurgery, hand surgery for congenital syndactyly refers to provide theoretical support and new operation mode of repair webbed reconstruction.Methods:Based on the anatomical studies according to the finger after the mean shape web skin defect area and wound, design the appropriate size and shape on the back of the hand corresponding intermetacarpal subcutaneous perforator pedicle dorsal metacarpal flap (flap around the incision and subcutaneous not free), and in 2007 May to 2012 November, reconstruction of congenital syndactyly 15 23 cases of side 28 refers to the web.Results:28 flaps survived, the biggest flap area 3*2cm, the minimum area of 1.5*lcm. After 14 cases of 22 sides of 26 flap was 10～22 months follow-up, an average of 14.5 months, the patient refers to the web of moderate size, the outline of the normal, metacarpophalangeal joint activity; web space two-point discrimination of 9-13 mm, average 11 mm. According to the evaluation standard of hand function after Swanson, bisection refers to the motor and sensory function evaluation: excellent in 18, good in 8,2, the excellent and good rate was 92.6%.Conclusion:refers to the web dorsal perforator flap reconstruction with slip, operation is simple and safe, has the advantages of beautiful appearance, the reconstructed finger web function and so on, is a congenital syndactyly refers to one of the best methods of reconstruction of web space. |
PDF Full Text Request