Shintani Kosuke, Takamatsu Kiyohito, Uemura Takuya, Onode Ema, Okada Mitsuhiro, Kazuki Kenichi, Nakamura Hiroaki
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka 545-8585, Japan; Department of Orthopaedic Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojima-ku, Osaka 534-0021, Japan.
Department of Orthopaedic Surgery, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-Ku, Osaka 533-0024, Japan.
J Plast Reconstr Aesthet Surg. 2016 May;69(5):634-9. doi: 10.1016/j.bjps.2016.01.003. Epub 2016 Feb 8.
Digital artery perforator (DAP) flaps have been applied for the coverage of finger soft tissue defects. Although an advantage of this method is that there is no scarification of the digital arteries, it is difficult to identify the location of the perforators during intraoperative elevation of the DAP flap. In this study, anatomically reliable locations of DAPs were confirmed using color Doppler ultrasonography (US) in healthy volunteers. A successful case using an adiposal-only DAP flap for the coverage of a released digital nerve using preoperative DAP mapping with color Doppler US is also described. A total of 40 digital arteries in 20 fingers of the right hands of five healthy volunteers (mean age: 32.2 years old) were evaluated. The DAPs were identified using color flow imaging based on the beat of the digital artery in the short axial view. In total, 133 perforators were detected, 76 (an average of 3.8 per finger) arising from the radial digital artery and 57 (an average of 2.9 per finger) arising from ulnar digital artery. Sixty-three perforators (an average of 3.2 per finger) in the middle phalanges and 70 (an average of 3.5 per finger) in the proximal phalanges were found. Overall, an average of 1.7 perforators from each digital artery was detected in the proximal or middle phalanges. Moreover, at least one DAP per phalanx was reliably confirmed using color Doppler US. Preoperative knowledge of DAP mapping could make elevating the DAP flap easier and safer.
指动脉穿支（DAP）皮瓣已被用于覆盖手指软组织缺损。尽管该方法的一个优点是不会造成指动脉的瘢痕形成，但在术中掀起DAP皮瓣时很难确定穿支的位置。在本研究中，使用彩色多普勒超声（US）在健康志愿者中确认了DAP在解剖学上的可靠位置。还描述了一例术前使用彩色多普勒超声进行DAP定位，成功应用仅含脂肪的DAP皮瓣覆盖松解后的指神经的病例。对5名健康志愿者右手20个手指中的40条指动脉进行了评估（平均年龄：32.2岁）。在短轴视图中，基于指动脉的搏动，使用彩色血流成像来识别DAP。总共检测到133个穿支，其中76个（平均每指3.8个）来自桡侧指动脉，57个（平均每指2.9个）来自尺侧指动脉。在中节指骨发现63个穿支（平均每指3.2个），在近节指骨发现70个穿支（平均每指3.5个）。总体而言，在近节或中节指骨中，每条指动脉平均检测到1.7个穿支。此外，使用彩色多普勒超声可靠地确认了每个指骨至少有一个DAP。术前了解DAP定位可以使掀起DAP皮瓣更容易、更安全。
