Tancharoen Chasari, Niumsawatt Vachara, Ek Edmund W, Thomas Damon J
Barwon Health, Department of Plastic, Reconstructive and Hand Surgery, Geelong Hospital, Geelong, Victoria, Australia.
ANZ J Surg. 2014 Jun;84(6):459-63. doi: 10.1111/ans.12172. Epub 2013 Apr 18.
Soft tissue defects of the digits can be a challenging problem for the hand surgeon. For non-graftable defects, numerous local, regional and free flaps have been described for resurfacing, each with their own limitations - bulk, colour, texture mismatch, donor morbidity. Perforator flaps increasingly provide the optimal option for reconstruction of digital defects as they are thin, pliable and with low donor site morbidity.
A thin, pliable fasciocutaneous flap can be raised from the distal volar forearm based on a perforator of the radial artery. The pedicle is up to 2-3 cm in length with a diameter of at least 0.5 mm in diameter, suitable for anastomosis to the digital artery. Venous drainage is via the venae comitante of the radial artery and superficial volar veins.
A patient presented to our emergency department following circular saw injuries. He suffered multi-digit trauma with subsequent soft tissue defects over the dorsum of the digit. Reconstructive requirements were met utilizing a free fasciocutaneous flap raised on a distal volar forearm perforator from the radial artery. The recovery was uneventful with no donor site morbidity.
Dorsal digital soft tissue reconstruction requires thin, pliable, ideally hairless and sensate skin. Most locoregional options are limited by the need for multi-stage surgery, bulk, limited reach or donor site morbidity. In our patient, the reconstructive requirements were met with preservation of the radial artery. While it requires microsurgical skill and instruments, this flap provides another option for the reconstructive hand surgeon.
手指的软组织缺损对于手外科医生而言可能是一个具有挑战性的问题。对于无法进行移植的缺损，已有众多局部、区域和游离皮瓣用于创面修复，每种皮瓣都有其自身的局限性——体积、颜色、质地不匹配以及供区并发症。穿支皮瓣因其薄、柔韧且供区并发症少，越来越成为修复手指缺损的理想选择。
基于桡动脉的一个穿支，可从前臂掌侧远端掀起一个薄且柔韧的筋膜皮瓣。蒂长可达2 - 3厘米，直径至少0.5毫米，适合与指动脉吻合。静脉回流通过桡动脉的伴行静脉和掌侧浅静脉。
一名患者因圆锯伤就诊于我们的急诊科。他遭受了多手指创伤，随后手指背侧出现软组织缺损。利用基于桡动脉前臂掌侧远端穿支掀起的游离筋膜皮瓣满足了重建需求。恢复过程顺利，供区无并发症。
手指背侧软组织重建需要薄、柔韧、理想情况下无毛且有感觉的皮肤。大多数局部区域选择受限于需要多阶段手术、体积、覆盖范围有限或供区并发症。在我们的患者中，在保留桡动脉的情况下满足了重建需求。虽然它需要显微外科技术和器械，但这种皮瓣为手外科重建医生提供了另一种选择。
