The Anatomy Basic And Clinical Applications On The Dorsal Perforator Flap Of The Deep Palmar Arch

Objective:? To investigate the morphological characters of the dorsal perforators origined from the deep palmar arch,for providing anatomic knowledge of V-Y advanced perforator flap.?To investigate the clinical features ofthe flap based on the perforator of the Deep palmar arch,and provide the clinical evidence for the promotion of this flap.Method:? Microscopic anatomy: The following contents were investigated in 31 adult hand specimens perfused with red latex under surgical magnifier:(1)The origin,courses,branches and distribution of the dorsal perforators origined from the deep palmar arch.(2)The characters of anastomosis among the dorsal perforators,the dorsal carpal and metacarpal arteries.Mimic operation was performed on another fresh specimens perfused with red latex.macro-micro-anatomy and mimic surgery and the anatomical images were taken by a digital camera.The data were collected and analyzed.? Clinical application: Form October 2016 to December 2017,there were 7patients accepted the surgry with the dorsal perforators origined from the deep palmar arch in the reconstruction of skin defects of the dorsal metacarpal: 2 the first web soft tissue defects;5 dorsal metacarpal soft tissue defects.The clinical images were taken by a digital camera and the patients were followed up and assessed after the operation.Results:?There were three perforators origined from the deep palmar arch,which passed through the 2nd~4th dorsal interossei and then divided into an ascending branch and a descending branch at the dorsum of hand.Then the ascending branch anastomosed with the dorsal carpal artery,and the descending branch stretched to the 2nd-4th dorsal metacarpal arteries.The originating outer diameters of the 1st-3rd perforators were(1.1±0.2)mm,(0.9±0.3)mm and(0.7±0.1)mm respectively,and the length of the stems were(1.1±0.3)cm,(1.0±0.2)cm and(0.9±0.1)cm respectively?? Clinical applications: 7 cases with skin and soft-tissue defects on the dorsal metacarpal were treated with the flap based on the perforator of the deep palmar arch.All the flaps survived after operation,all these cases were conducted with a follow-up period for 5-12months(average,7 months).And the incisions in recipient and donor sites were primarily healing.All the flap based on the perforator of the deep palmar arch demonstrated asatisfactory appearance and favorable sense function.The reconstructed hands characteristic was good,with no obvious scar hyperplasia.The range of flexion and extension of reconstructed hands was favorable as well.Conclusion:? The dorsal perforators origined from the deep palmar arch have such advantages as high occurrence rate,constant perforating position and abundant anastomosis with the dorsal metacarpal artery branches.The V-Y advanced perforator flap with the dorsal perforator of the deep palmar arch as its vascular pedicle could be used to repair the dorsal metacarpal soft tissue defects.? This flap is adjacent in position and similar in texture to the recipient site,therefore,the appearance,function and sense would recover well after the restoration.the flap based on the perforator of the deep palmar arch is an ideal selection for plastic surgery of reconstructed the dorsal metacarpal.