Beltrán Aldo G, Romero Camilo J
Hospital Central Policía Nacional de Colombia, Bogotá, Colombia; Clínica Partenón, Bogotá, Colombia; Liberty ARL, Bogotá, Colombia.
Fundación CardioInfantil, Bogotá, Colombia; Instituto de Ortopedia Infantil Roosevelt, Bogotá, Colombia.
Hand (N Y). 2017 Jan;12(1):91-97. doi: 10.1177/1558944716646781. Epub 2016 May 3.
The management of contractures and soft tissue defects in the proximal interphalangeal (PIP) finger joint remains a challenge. We report a transposition flap from the lateral skin of the proximal phalanx that is based on perforating branches of the digital arteries and can be used safely for both palmar and dorsal cover defects. We first completed an anatomic study, dissecting 20 fingers in fresh cadavers with arterial injections and made the new flap in patients with dorsal or palmar defects in PIP joints. In cadavers, we can reveal 4 constant branches from each digital artery in the proximal phalanx, with the more distal just in the PIP joint constituting the flap pedicle. Between February 2010 and February 2015, we designed 33 flaps in 29 patients, 7 for dorsal and 26 for palmar defects, with no instances of flap necrosis and 4 distal epidermolysis. The patients were between 4 and 69 years with no major complications, and all of the skin defects in the PIP joint were resolved satisfactorily without any relevant sequelae at the donor site. This flap procedure is an easy, reliable, versatile, and safe technique, and could be an important tool for the management of difficult skin defects and contractures at the PIP joint level.
近端指间（PIP）关节挛缩和软组织缺损的处理仍然是一项挑战。我们报告一种基于指动脉穿支的近节指骨外侧皮瓣转位术，可安全用于手掌和手背的覆盖缺损。我们首先完成了一项解剖学研究，对20个新鲜尸体手指进行动脉注射解剖，并在患有PIP关节背侧或掌侧缺损的患者中制作了新皮瓣。在尸体中，我们发现每个指动脉在近节指骨有4个恒定分支，其中最远端恰好在PIP关节处构成皮瓣蒂。2010年2月至2015年2月，我们为29例患者设计了33个皮瓣，其中7个用于背侧缺损，26个用于掌侧缺损，无皮瓣坏死病例，4例出现远端表皮松解。患者年龄在4岁至69岁之间，无重大并发症，PIP关节处的所有皮肤缺损均得到满意解决，供区无任何相关后遗症。这种皮瓣手术是一种简单、可靠、通用且安全的技术，可能是处理PIP关节水平困难皮肤缺损和挛缩的重要工具。
