Chi Zhenglin, Yang Peng, Song Dajiang, Li Zan, Tang Liang, Gao Weiyang, Song Yonghuan, Chu Tingang
Department of Orthopedic Surgery, Division of Plastic and Hand Surgery, The Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, China.
Department of Orthopedic Trauma Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Surg Radiol Anat. 2017 May;39(5):547-557. doi: 10.1007/s00276-016-1760-4. Epub 2016 Oct 21.
To investigate the results of resurfacing completely degloved digits using bilobed innervated radial artery superficial palmar branch (RASPB) perforator flap in a spiral fashion.
A detailed anatomic study on 30 adult fresh frozen cadavers preinjected with silicone rubber compound to demarcate arterial anatomy documented locations, numbers, and diameters of arteries and skin perforators with surrounding nerves. The flap-raising procedure was performed using four fresh cadaver specimen. We reviewed the reconstruction of 12 digits by using a bilobed spiraled innervated RASPB free perforator flap after non-replantable degloving injury. Two skin paddles were marked out using standard points of reference. At least two separate cutaneous perforator vessels were identified using a hand-held Doppler and were dissected back to the RASPB in retrograde fashion. The skin paddles were then divided between the two cutaneous perforators to provide two separate paddles with a common vascular supply. The skin paddles were stacked in a spiral fashion on the flap inset, effectively increasing the width of the flap to cover the totally degloved finger while still allowing closure of the primary donor-site.
The RASPB was present within the flap in all cadavers. The direct perforator and the musculocutaneous perforator were available in 93.33 and 76.67 %, respectively, with neither of them in 6.67 % of the cases. The constantly present two perforators allowed the design of a new bilobed spiraled innervated radial artery superficial palmar branch perforator flap. We used the proposed flap to reconstruct completely degloved digits in 12 patients (mean age 28.6 years; range 17-35 years). With our proposed flap, no flap failure or re-exploration occurred and the donor site was closed primarily in all cases. All the flaps survived uneventfully. Total active motion ranged from 92° to 140° and 111° to 155° in the cases with and without metacarpophalangeal joint involvement, respectively. The static 2 point discrimination test varied from 6 to 11 mm. All the patients were satisfied with the overall results.
The bilobed flap is large enough to cover totally degloved finger defects and contain direct skin perforators, provides a bespoke cover for complex soft tissue defects of completely degloved digits while also improving morbidity and cosmesis of the donor site.
Level IV, retrospective series.
探讨采用双叶带神经桡动脉掌浅支（RASPB）穿支皮瓣螺旋式修复完全脱套手指的效果。
对30例预先注射硅橡胶混合物以明确动脉解剖结构的成年新鲜冷冻尸体进行详细的解剖学研究，记录动脉、皮肤穿支及其周围神经的位置、数量和直径。使用4例新鲜尸体标本进行皮瓣切取操作。回顾性分析12例不可再植性脱套伤后采用双叶螺旋带神经RASPB游离穿支皮瓣修复手指的病例。利用标准参考点标记出两个皮瓣。使用手持式多普勒超声识别至少两条独立的皮穿支血管，并逆行解剖至RASPB。然后在两条皮穿支之间划分皮瓣，形成两个具有共同血供的独立皮瓣。将皮瓣以螺旋方式堆叠于皮瓣植入部位，有效增加皮瓣宽度以覆盖完全脱套的手指，同时仍可直接闭合供区。
所有尸体的皮瓣中均存在RASPB。直接穿支和肌皮穿支的出现率分别为93.33%和76.67%，6.67%的病例两者均未出现。持续存在的两条穿支使得设计一种新的双叶螺旋带神经桡动脉掌浅支穿支皮瓣成为可能。我们采用该皮瓣修复了12例患者（平均年龄28.6岁；范围17 - 35岁）的完全脱套手指。采用我们设计的皮瓣，未发生皮瓣坏死或再次手术探查，所有病例供区均直接闭合。所有皮瓣均顺利存活。有掌指关节受累和无掌指关节受累的病例中，总的主动活动度分别为92°至140°和111°至155°。静态两点辨别觉测试结果为6至11毫米。所有患者对总体结果均满意。
双叶皮瓣足够大以覆盖完全脱套的手指缺损且包含直接皮肤穿支，为完全脱套手指的复杂软组织缺损提供定制化覆盖，同时还可改善供区的发病率和美观度。
四级，回顾性系列研究。
