Usami Satoshi, Okazaki Mutsumi, Nitta Tomohisa, Uemura Noriko, Homma Tsutomu, Akita Keiichi
a Department of Plastic and Reconstructive Surgery , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan.
b Department of Clinical Anatomy , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan.
J Plast Surg Hand Surg. 2017 Jun;51(3):182-186. doi: 10.1080/2000656X.2016.1213733. Epub 2016 Aug 15.
Many skin flaps have been described for fingertip reconstruction; however, they have not been compared histologically. The aim of this study is to compare the histological features of common insensate flaps that are used for fingertip reconstruction.
Skin from fingertips and common flap donor sites on the hand and forearm of cadavers were harvested. This study investigated four histological characteristics, namely thickness of the epidermis and dermis; the ratio of collagen to elastic fibres (C/E ratio) in subdermal tissues, and distribution densities of Merkel cells and Meissner's corpuscles. It then compared the values obtained to determine which flap donor site best matched the fingertip.
Epidermal thickness of the reverse digital artery island flap, thenar flap, and hypothenar flap was similar to that of fingertip tissue; dermal thickness of the hypothenar flap was similar to that of fingertip tissue. The C/E ratio of the reverse digital artery island flap was similar to that of fingertip tissue. Merkel cells were abundant in the reverse digital artery island flap, but Meissner's corpuscles were few in each of the flaps compared with fingertip tissue.
The flap donor site with histological properties most similar to fingertip tissue was the palmar lateral aspect at the finger base, representative of the reverse digital artery island flap with respect to epidermal thickness, C/E ratio, and presence of Merkel cells. The thenar and hypothenar flaps also showed similar properties.
已有多种皮瓣用于指尖重建的描述；然而，尚未对它们进行组织学比较。本研究的目的是比较用于指尖重建的常见感觉缺失皮瓣的组织学特征。
采集尸体手部和前臂指尖及常见皮瓣供区的皮肤。本研究调查了四个组织学特征，即表皮和真皮的厚度；皮下组织中胶原与弹性纤维的比例（C/E 比），以及默克尔细胞和迈斯纳小体的分布密度。然后比较所得值以确定哪个皮瓣供区与指尖最匹配。
逆行指动脉岛状皮瓣、大鱼际皮瓣和小鱼际皮瓣的表皮厚度与指尖组织相似；小鱼际皮瓣的真皮厚度与指尖组织相似。逆行指动脉岛状皮瓣的 C/E 比与指尖组织相似。逆行指动脉岛状皮瓣中默克尔细胞丰富，但与指尖组织相比，各皮瓣中的迈斯纳小体均较少。
组织学特性与指尖组织最相似的皮瓣供区是手指基部的掌外侧，就表皮厚度、C/E 比和默克尔细胞的存在而言，代表逆行指动脉岛状皮瓣。大鱼际和小鱼际皮瓣也表现出相似的特性。
