Kodaira Satoshi, Fukumoto Keizo, Kato Naoki
Saitama Hand Surgery Institute, Saitama Seikeikai Hospital, Saitama, Japan.
Tech Hand Up Extrem Surg. 2018 Jun;22(2):68-71. doi: 10.1097/BTH.0000000000000192.
Various flaps are used for skin defects of the dorsal hand and fingers. A sensory flap is not essential, but a thin and good color-matched flap is suitable, and donor site mobility of the flap should be considered. A reverse or free posterior interosseous artery perforator flap is one of the standard flaps. This flap requires no major arterial sacrifice, but direct closure of the donor site is difficult when the width of the flap is >3 cm, and there is also the risk of posterior interosseous nerve injury, especially the motor branch of the extensor carpi ulnaris muscle. The deltoid or acromial branch of the thoracoacromial artery has a large skin perforator, and this perforator is the vascular pedicle of the free thoracoacromial artery perforator flap. This flap is not bulky, is pliable and well color-matched for the dorsal hand, and direct closure of the donor site is easier than the posterior interosseous artery perforator flap. A free thoracoacromial artery perforator flap based on the deltoid or acromial branch is a good option for dorsal hand and finger reconstruction.
各种皮瓣用于手背和手指的皮肤缺损。感觉皮瓣并非必需，但薄且颜色匹配良好的皮瓣是合适的，并且应考虑皮瓣供区的活动度。逆行或游离骨间后动脉穿支皮瓣是标准皮瓣之一。该皮瓣无需牺牲主要动脉，但当皮瓣宽度>3 cm时，供区直接缝合困难，且存在骨间后神经损伤的风险，尤其是尺侧腕伸肌的运动支。胸肩峰动脉的三角肌或肩峰支有一个大的皮肤穿支，该穿支是游离胸肩峰动脉穿支皮瓣的血管蒂。该皮瓣不臃肿，质地柔韧，与手背颜色匹配良好，且供区直接缝合比骨间后动脉穿支皮瓣更容易。基于三角肌或肩峰支的游离胸肩峰动脉穿支皮瓣是手背和手指重建的良好选择。
