Kim Jihyeung, Lee Young Ho, Kim Min Bom, Lee Seung Hoo, Baek Goo Hyun
Seoul, South Korea From the Department of Orthopedic Surgery, Seoul National University College of Medicine.
Plast Reconstr Surg. 2015 Jun;135(6):1643-1650. doi: 10.1097/PRS.0000000000001290.
The reverse digital artery flap uses the radial or ulnar surface of the proximal phalanx of the involved digit and has been applied to sensate flaps using the superficial sensory nerve branch and the dorsal branch of the proper digital nerve. As these nerve branches innervate the dorsal surface of the finger, however, hypesthesia of the dorsal side of the middle phalanx is inevitable.
Thirty fingers of 25 patients who had the innervated reverse digital artery flap using direct small branches of the proper digital nerve were included in this study. The minimum follow-up duration was 24 months, and the average defect size was 2.8 cm(2).
In all cases, the pulp defects were successfully reconstructed with this flap. The average size of the donor flap was 3.9 cm(2). At 6 months after surgery, the average static two-point discrimination value was 5.9 mm, the average moving two-point discrimination value was 5.0 mm, and the average Semmes-Weinstein monofilament score was 3.79. At 1 year postoperatively, the average Cold Intolerance Severity Score was 20. The percentage total active motion was measured at 99 percent 2 years after surgery.
Because this flap does not sacrifice the proper digital nerve or dorsal branch of the nerve, the sensibility of the dorsal aspect of the proximal and middle phalanx can be preserved. This flap is cosmetically excellent, as it uses a donor flap similar to the injured fingertip and the donor scar can be hidden by adjacent fingers.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
逆行指动脉皮瓣利用患指近节指骨的桡侧或尺侧，且已应用于采用浅感觉神经分支和指固有神经背支的感觉皮瓣。然而，由于这些神经分支支配手指背侧，中节指骨背侧感觉减退不可避免。
本研究纳入了25例患者的30指，这些患者采用指固有神经直接小分支进行带神经逆行指动脉皮瓣修复。最短随访时间为24个月，平均缺损面积为2.8平方厘米。
所有病例中，该皮瓣均成功修复了指腹缺损。供区皮瓣平均面积为3.9平方厘米。术后6个月，平均静态两点辨别觉值为5.9毫米，平均动态两点辨别觉值为5.0毫米，平均Semmes-Weinstein单丝试验评分为3.79。术后1年，平均冷不耐受严重程度评分为20分。术后2年测量的总主动活动百分比为99%。
由于该皮瓣不牺牲指固有神经或其背支，近节和中节指骨背侧的感觉可得以保留。该皮瓣美容效果极佳，因为其供区皮瓣与受伤指尖相似，且供区瘢痕可被相邻手指遮挡。
临床问题/证据水平：治疗性，IV级。
