Barrera-Ochoa Sergi, Mendez-Sanchez Gerardo, Rodriguez-Baeza Alfonso, Knörr Jorge, Bertelli Jayme Augusto, Soldado Francisco
Pediatric Hand Surgery and Microsurgery Unit, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain.
Hand and Microsurgery Unit, Hospital Universitari Quiron-Dexeus, ICATME, Barcelona, Spain.
Microsurgery. 2019 Jan;39(1):62-69. doi: 10.1002/micr.30233. Epub 2017 Sep 14.
Through an anatomical review, the primary aim of this study was to delineate the dorsal thumb metacarpal (TM) periosteal branches of the radial artery (RA). In addition, we report here the clinical utility of a vascularized TM periosteal pedicled flap (VTMPF), supplied by the first dorsal metacarpal artery (FDMA), in a complex case of scaphoid nonunion.
Ten latex-colored upper limbs from fresh human cadavers were used. Branches of the RA were dissected under 3x loupe magnification, noting the periosteal branches arising from the FDMA. The VTMPF was measured for both length (cm) and width (cm).
The FDMA provided a mean 12 periosteal branches (range 9 to 15), with a mean distance between branches of 0.5 cm (range 0.2-1.1), allowing for the design of a VTMPF which measured a mean 4 cm in length and 1.2 cm in width. We used a VTMPF to treat recalcitrant scaphoid nonunion, with a volar defect of 0.7 cm, in a 16-year-old boy. No bone graft was used. The patient experienced no postoperative complications. Successful consolidation was achieved three months after surgery, confirming the flap's survival. At 14-months of postoperative follow-up, the patient's VAS pain rating was 0 out of 100, and his DASH questionnaire score was 5. The patient had painless range that was 95% that of the contralateral limb. The patient's pinch and grip strengths were 6.5 kg and 28 kg, respectively (95% of unaffected side).
VTMPF may be considered a valuable and reliable surgical option for scaphoid nonunion in complex clinical scenarios.
通过解剖学研究，本研究的主要目的是描绘桡动脉（RA）的拇指背侧掌骨（TM）骨膜支。此外，我们在此报告由第一掌背动脉（FDMA）供血的带血管蒂的TM骨膜瓣（VTMPF）在舟骨不愈合复杂病例中的临床应用。
使用来自新鲜人类尸体的10个涂有乳胶的上肢。在3倍放大镜下解剖RA的分支，记录从FDMA发出的骨膜支。测量VTMPF的长度（厘米）和宽度（厘米）。
FDMA平均发出12支骨膜支（范围为9至15支），支间平均距离为0.5厘米（范围为0.2 - 1.1厘米），这使得能够设计出平均长度为4厘米、宽度为1.2厘米的VTMPF。我们使用VTMPF治疗一名16岁男孩的顽固性舟骨不愈合，掌侧缺损0.7厘米。未使用骨移植。患者术后无并发症。术后三个月实现成功愈合，证实了皮瓣存活。术后14个月随访时，患者的视觉模拟评分（VAS）疼痛评分为0（满分100），DASH问卷评分为5分。患者无痛活动范围为对侧肢体的95%。患者的捏力和握力分别为6.5千克和28千克（为未受影响侧的95%）。
在复杂的临床情况下，VTMPF可被视为治疗舟骨不愈合的一种有价值且可靠的手术选择。
