| Objective: 1.To study the anatomy of the superficial metacarpal branch of radial artery(Superficial Palmar Branch of Radial Artery,SPBRA)by high frequency color Doppler,to describe the anatomical characteristics of SPBRA under ultrasound,and to determine the value of accurate localization of high frequency color Doppler in the clinical application of SPBRA perforator free flap.2.To evaluate the clinical effect of free SPBRA perforator flap in repairing finger skin defect from both objective and subjective aspects,so as to provide a basis for clinical selection of SPBRA perforator free flap as a way to repair finger skin defect.Methods: 1.Anatomical study of SPBRA under ultrasound:115 healthy adult volunteers were selected to investigate the presence and mutation of SPBRA in the main artery of distal palmar Radial Artery(RA)of the forearm by high-frequency color Doppler.The distance of SPBRA from the RA trunk to the scaphoid tubercle,the diameter and velocity of SPBRA at the level of the scaphoid tubercle were measured and recorded.The measured results were analyzed statistically,and the anatomical characteristics of SPBRA ultrasound were described.2.Clinical effect analysis of SPBRA Perforator free flap.A total of 42 patients(25 males,17 females,age 39.7±12.4 years)who underwent wound repair by SPBRA perforator free flap due to hand skin and soft tissue defects in our hospital from 2016 to 2022 were selected for this study.All subjects had complete clinical data and volunteered to cooperate with the study.Preoperative high frequency color Doppler precise positioning and surgical treatment.Follow-up was conducted from objective and subjective aspects after operation.(1)Objective evaluation:(1)General follow-up;(2)Vancouver Scar Scale(VSS)was used to evaluate scarring of the wrist;(3)Range of Motion(ROM)was measured;(4)recovery of sensation in the flap:Quantitative Sensory Testing(QST)and Two-point Discrimination(2-PD)were used to evaluate sensory recovery in the flap.(2)Subjective evaluation: The Brief Michigan Hand out-comes Questionnaire(BMHQ)was used to evaluate patients’ subjective satisfaction after surgery.3.Statistical analysis: Data in this study were expressed in the format of(X±S),and IBMSPSSStatistics29.0 was used for statistical analysis of SPBRA anatomical data under ultrasound and patient follow-up data,and p<0.05 was considered to be statistically significant.Results: 1.Anatomical characteristics of SPBRA under ultrasound: A total of 115 volunteers,including 42 females and 73 males,aged 36.8±13.1 years,66 volunteers(25 females and 41males)were measured in bilateral symmetry.115 people measured 181 hands,including 89 right hands and 92 left hands.(1)The positive rate of RA trunk was 100% in 181 cases,SPBRA trunk was detected in 179 cases(99%),and SPBRA absence variant was detected in 2 cases(1%),all of which were in the right hand.There were 5 cases(3%)with diameter >2mm(2.3±0.3mm).5 cases(3%)had high branch type variation(the distance from main RA to scaphoid tubercle >45mm),and the distance from scaphoid tubercle was 68.9±19.4mm.The total variation was 12 cases(7%).(2)The horizontal tube diameter of SPBRA at scaphoid tubercle was 1.0±0.4mm,the flow velocity was 16.6±12.7cm/s,and the distance of SPBRA from RA trunk to scaphoid tubercle was 22.6±12.0mm.There was no linear correlation between the above anatomical features and age.(1)SPBRA tube diameter at scaphoid nodule level was 1.0±0.4mm on the left and 0.9±0.3mm on the right.The blood flow velocity was 14.8±8.6cm/s on the left and 18.3±16.8cm/s on the right.The distance from the emitting location to the scaphoid tubercle was 20.6±8.9mm on the left and 24.4±14.3mm on the right.There was no statistical significance in the difference of SPBRA diameter,flow velocity and emission position between left and right hands(p>0.05).(2)The pipe diameter of SPBRA was 0.9±0.3mm for female and 1.0±0.4 mm for male.The velocity was 13.4±7.6 cm/s for females and18.3±14.6 cm/s for males.The distance to scaphoid tubercle was 20.8±12.7 mm for female and 23.8±11.4 mm for male.The pipe diameter and flow velocity of SPBRA were significantly different between men and women(p < 0.05).There was no significant difference between genders in the distance from the location of the origin to scaphoid tuberosity(p > 0.05).2.Analysis of the curative effect of SPBRA perforator free flap accurately located by high frequency color Doppler before operation:(1)objective evaluation:(1)General follow-up: a total of 42 patients were followed up for 36.2 ±13.5months.There were no adverse complications such as infection,vascular crisis and necrosis after free skin flap transplantation.The donor area of the wrist was sutured twice in 1 patient.The skin flap of 29 patients had poor tolerance to hypothermia.Up to the last follow-up,all the flaps of 42 patients survived,the shape of the flap was good,there was no contracture,and the color was similar to that of the surrounding skin.There were no complications.None of the patients underwent secondary flap repair.There was no obvious pain in the skin flap in daily life.(2)the VSS score of scar in the donor area of the wrist: the total score was 5.0±1.9,including scar pigmentation,scar vascularization,softness,and height above the skin surface.(3)The ROM of active flexion and extension of the wrist: the dorsal extension of the contralateral wrist was(52.0 ±6.5)°,the dorsal extension of the affected wrist was(50.2 ±7.8)°,the flexion of the healthy wrist was(45.6 ±7.5)°,and the flexion of the affected wrist was(43.3 ±8.5)°.There was no significant difference in active flexion and extension ROM between the affected side and the healthy side(p > 0.05).(4)sensory recovery of the flap: compared with the corresponding part of the healthy side,the cold threshold temperature of the flap decreased by(4.8 ±1.6)℃,the thermal threshold temperature increased by(4.8 ±1.9)℃,and the cold pain threshold temperature increased by(3.8 ±2.1)℃.The thermal pain threshold temperature increased by(3.7 ±0.9)℃,and the reaction time of vibration threshold increased by 0.78 ±0.18 s.S-2PD increased 6.2 ±2.0 mm and M-2PD increased 6.0 ±2.2 mm.The results of statistical analysis showed that the differences of cold sensation,heat sensation,cold pain sensation,thermal pain sensation,vibration sensation and 2-PD between the flap and the healthy side were linearly correlated with the follow-up time.With the increase of follow-up time,the threshold temperature of cold sensation,heat sensation,cold pain sensation,thermal pain sensation,response time of vibration perception threshold,and the absolute value of the difference between two-point discrimination and the healthy side of the flap decreased gradually.(2)the subjective satisfaction score of postoperative BMHQ patients was 87.9 ±14.5,including overall function 81.8 ±9.2,daily life 89.9 ±6.6,work and study 85.4 ±2.4,pain 90.8 ±12.8,appearance 88.4 ±6.6,satisfaction 91.4 ±11.3.The average score of each part was more than80,and the average score of single item about hand sensation was less than 80.Conclusion:1.High-frequency color Doppler can accurately locate SPBRA,and accurately measure and evaluate the existence,variation and hemodynamics of SPBRA.The accurate location of high frequency color Doppler before operation is of great significance for the transplantation of SPBRA perforator free flap.2.After repairing finger skin defect with SPBRA perforator free flap,the appearance of finger is good,and there is no complication.It has no effect on the appearance and movement of wrist donor area,and the feeling of the flap recovers well.The postoperative subjective satisfaction of the patients was high.SPBRA perforator free flap is a reliable choice for repairing skin and soft tissue defects of fingers. |
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