Al-Dhamin Ammar, Cox Joel, Bissell Mary Beth, Marciel-Miranda Alejandro, Morris Steven F
From the Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Ann Plast Surg. 2016 May;76(5):564-8. doi: 10.1097/SAP.0000000000000414.
The volar aspect of the thumb often requires local flaps for reconstruction. This study characterizes perforators of the princeps pollicis artery (PPA) and evaluates the potential of a local propeller-type flap raised using these perforators for reconstruction of these defects.
Cadavers underwent whole-body lead-oxide injection and were then imaged using a 64-slice spiral computed tomographic scanner. The DICOM images were imported into Materialise's Interactive Medical Imaging Control System (Materialise, Belgium) for 3-dimensional reconstruction of the microvasculature. The number, length, caliber, and location of perforators arising from the PPA were determined and a plot was generated illustrating the relative distribution of perforators.
A total of 16 PPA perforators were identified in the 8 specimen hands. Perforators had a mean (SD) diameter of 1.2 (0.4) mm and mean (SD) length of 8.9 (4.8) mm. The PPA perforators were consistently identified along the radial aspect of the thenar region. Seventy percent of all PPA perforators can be found over the distal 50% of the MC [20%-54%; mean (1SD)].
Perforators of the PPA were found in all hands and the average caliber and length of the perforators identified is sufficient for the creation of a local perforator flap. This, coupled with the mean location of these perforators, arising near the base of the thumb, confirms that a cutaneous flap from the thenar region can be raised based on this perforator as a propeller flap to obtain coverage of distal cutaneous defects of the thumb.
拇指掌侧通常需要局部皮瓣进行修复。本研究对拇主要动脉（PPA）的穿支进行了特征描述，并评估了利用这些穿支掀起的局部推进皮瓣修复这些缺损的潜力。
对尸体进行全身氧化铅灌注，然后使用64层螺旋计算机断层扫描仪进行成像。将DICOM图像导入Materialise的交互式医学影像控制系统（Materialise，比利时）进行微血管系统的三维重建。确定来自PPA的穿支数量、长度、管径和位置，并绘制图表说明穿支的相对分布。
在8只标本手中共识别出16个PPA穿支。穿支的平均（标准差）直径为1.2（0.4）mm，平均（标准差）长度为8.9（4.8）mm。PPA穿支始终沿鱼际区域的桡侧被识别。所有PPA穿支的70%可在掌骨远端50%范围内找到[20%-54%；平均（1标准差）]。
在所有手中均发现了PPA穿支，所识别的穿支平均管径和长度足以用于制作局部穿支皮瓣。这一点，再加上这些穿支的平均位置在拇指基部附近，证实了可以基于该穿支从鱼际区域掀起一个皮瓣作为推进皮瓣，以覆盖拇指远端皮肤缺损。
