Department of Orthopedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Department of Comparative Medicine, Fuzong Clinical Medical College of Fujian Medical University (The 900th Hospital of PLA), Fuzhou, China.
Clin Anat. 2020 Nov;33(8):1144-1151. doi: 10.1002/ca.23554. Epub 2020 Jan 8.
Soft-tissue defects on the dorsal hand accompanied by exposed bone and tendon remain a challenge for plastic surgeons. The purpose of this study was to observe the morphological characteristics of the dorsal carpal perforators in the wrist and to design a V-Y advancement flap based on the dorsal carpal perforators.
Thirty cadaveric hand specimens were dissected to observe the origin, course, branches, and anastomoses of the dorsal carpal perforators, and a V-Y advancement flap was designed based on these perforators. Clinically, nine cases of dorsal hand defects were reconstructed with this flap.
The dorsal carpal vascular network was formed by vascular anastomoses along the dorsal carpal branch of the radial artery, dorsal carpal branch of the anterior interosseous artery, ascending branch of the dorsal carpal perforator from the deep palmar arch, direct branch of the radial artery, dorsal carpal branch of the ulnar artery, posterior interosseous artery, and deep palmar branch of the ulnar artery; this network could be divided into a deep vascular network and superficial vascular network according to the anatomical plane. Among the perforators, the third and fourth perforators that pierce out bilaterally from the tendon of the extensor digitorium had a consistent occurrence rate (100%) with an outer diameter of 0.7 ± 0.3 mm and 0.6 ± 0.2 mm, respectively, and thus could be chosen as the vascular pedicle. In clinical applications, all flaps survived completely with excellent color and texture, a satisfactory appearance, and normal movement of the wrist joint.
A V-Y advancement flap based on the dorsal carpal perforators can become a useful choice for the repair of dorsal metacarpal defects caused by trauma or dorsal metacarpal arterial flaps.
手背伴有暴露骨和肌腱的软组织缺损仍然是整形外科医生面临的挑战。本研究旨在观察腕部背侧皮穿支的形态学特征，并基于背侧皮穿支设计 V-Y 推进皮瓣。
对 30 例手部标本进行解剖，观察背侧皮穿支的起源、走行、分支和吻合情况，并根据这些皮穿支设计 V-Y 推进皮瓣。临床应用该皮瓣修复 9 例手背缺损。
背侧皮血管网由桡动脉背侧分支、骨间前动脉背侧分支、掌深弓背侧穿支升支、桡动脉直接分支、尺动脉背侧分支、骨间后动脉和尺动脉掌深支的血管吻合形成；根据解剖平面可将其分为深、浅血管网。穿支中，从伸肌腱两侧穿出的第三、四穿支出现率一致（100%），外径分别为 0.7±0.3mm 和 0.6±0.2mm，可作为血管蒂。临床应用中，所有皮瓣均完全存活，色泽和质地良好，外观满意，腕关节活动正常。
基于背侧皮穿支的 V-Y 推进皮瓣可成为修复创伤或背侧骨间动脉皮瓣引起的掌骨背侧缺损的一种有用选择。
