Nanno Mitsuhiko, Kodera Norie, Tomori Yuji, Hagiwara Yusuke, Takai Shinro
Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan.
J Orthop Surg (Hong Kong). 2017 Jan;25(1):2309499016684744. doi: 10.1177/2309499016684744.
The second dorsal metacarpal (SDMC) perforator flap has been widely used for the soft tissue reconstruction of the hand. However, it is difficult to identify the depth and branches of the perforators of the second dorsal metacarpal artery (SDMA) using only handheld acoustic Doppler flowmetry (HADF), which is the most common method. The purpose of this study was to compare the results of examination by color Doppler ultrasonography (CDU) with those of HADF and to evaluate the efficacy of CDU for detection of the perforators to be used in the design of the SDMC flap.
Twenty-two healthy volunteers (42 hands) were examined using both CDU and HADF. All locations identified as the perforators of the SDMA by the two examinations were mapped respectively.
The total perforator arteries detected with CDU in all hands were 111 branches, 49 branches of which could not be identified with HADF. The average number of perforators of the SDMA per hand found with CDU was 2.8 branches, while that for HADF was only 1.8 branches. The detection rates of the cutaneous perforators of the SDMA by CDU were 100% in the proximal one-third of the second metacarpal and 95% in the distal one-fourth of the second metacarpal.
This study demonstrated the superiority of CDU compared with HADF for detection of the perforators of the SDMA. The CDU examination could easily identify the locations of the cutaneous perforators and help in the useful assessment of vascularity for the SDMC flap.
第二掌背动脉穿支皮瓣已广泛应用于手部软组织重建。然而，仅使用手持式声学多普勒血流仪（HADF）这一最常用的方法，很难确定第二掌背动脉（SDMA）穿支的深度和分支。本研究的目的是比较彩色多普勒超声（CDU）与HADF的检查结果，并评估CDU在检测用于设计第二掌背动脉穿支皮瓣的穿支方面的有效性。
对22名健康志愿者（42只手）同时使用CDU和HADF进行检查。分别绘制两种检查均确定为SDMA穿支的所有位置。
所有手中用CDU检测到的穿支动脉总数为111支，其中49支用HADF无法识别。用CDU发现的每只手SDMA穿支的平均数量为2.8支，而用HADF检测到的平均数量仅为1.8支。CDU对第二掌骨近端三分之一处SDMA皮穿支的检出率为100%，对第二掌骨远端四分之一处的检出率为95%。
本研究证明了CDU在检测SDMA穿支方面优于HADF。CDU检查可以轻松识别皮穿支的位置，并有助于对第二掌背动脉穿支皮瓣的血供进行有效评估。
