Orbay Jorge L, Rosen Joseph Gregory, Khouri Roger K, Indriago Igor
Miami Hand Center, Miami, FL, USA.
Tech Hand Up Extrem Surg. 2009 Sep;13(3):145-50. doi: 10.1097/BTH.0b013e3181ac9183.
We devised a new flap using the palmar cutaneous branch of the superficial radial artery proximally and anastomosed with a cutaneous perforator of the superficial palmar arch distally. We named our flap "the volar glabrous palmar flap." The flap was used both as a free flap and as a reverse-flow island flap. Thirty-six patients with volar hand defects (24 digits, 7 palms, and 5 first web space) were reconstructed with this flap. The flap was used as a proximally based free flap in 15 patients and was used as a reverse-flow island flap based on distal communication in the remaining 21 patients. Free flaps were supplied by the palmar branch of the superficial radial artery and its fasciocutaneous extensions; reverse-flow island flaps were supplied by one of the perforating branches of the superficial palmar arch, which is connected to the proximal fasciocutaneous branches. Flaps extended from the wrist crease to the proximal palmar crease and were designed medially on the thenar crease, extending 2 to 2.5 cm laterally. Flap sizes ranged from 1.5 x 2.2 cm to 2.5 x 10 cm. The palmar cutaneous branch of the median nerve within the flap area was identified and then was sutured to the divided digital nerve in 6 cases of finger pulp defect. The donor sites were closed and repaired primarily in most cases. The postoperative course was uneventful, and all the flaps survived without major complications. Follow-up (minimum 6 mo, mean 24 mo) showed excellent functional and cosmetic results. Satisfactory sensory reinnervation was achieved in patients who underwent sensory flap transfer for pulp defects. At the same time, we studied 6 cadaver hands to understand the vascular anatomy of the thenar area of the hand. We also revised several published anatomic papers to obtain a refined and scrutinized understanding of the palmar anatomy.
我们设计了一种新的皮瓣，近端采用桡动脉浅支的掌侧皮支，远端与掌浅弓的皮穿支吻合。我们将这种皮瓣命名为“手掌无毛掌侧皮瓣”。该皮瓣既可用作游离皮瓣，也可用作反流岛状皮瓣。36例手掌掌侧缺损患者（24指、7个手掌和5个第一掌骨间隙）采用该皮瓣进行修复。15例患者将皮瓣用作近端蒂游离皮瓣，其余21例患者将皮瓣用作基于远端交通支的反流岛状皮瓣。游离皮瓣由桡动脉浅支的掌侧支及其筋膜皮延伸支供血；反流岛状皮瓣由掌浅弓的穿支之一供血，该穿支与近端筋膜皮支相连。皮瓣从腕横纹延伸至近端掌横纹，在鱼际横纹内侧设计，向外侧延伸2至2.5厘米。皮瓣大小从1.5×2.2厘米至2.5×10厘米不等。在6例指腹缺损病例中，识别皮瓣区域内正中神经的掌侧皮支，然后将其缝合至离断的指神经。大多数情况下，供区直接缝合修复。术后过程顺利，所有皮瓣均存活，无严重并发症。随访（最短6个月，平均24个月）显示功能和美容效果良好。接受感觉皮瓣转移修复指腹缺损的患者获得了满意的感觉再支配。同时，我们研究了6具尸体手，以了解手部鱼际区域的血管解剖结构。我们还查阅了几篇已发表的解剖学论文，以获得对手掌解剖结构更精确、更详尽的认识。
