Institut Européen de la Main, Hôpital Kirchberg Medical Training Center, 9, rue Edward Steichen, 2540 Luxembourg, Luxembourg.
Institut Européen de la Main, Hôpital Kirchberg Medical Training Center, 9, rue Edward Steichen, 2540 Luxembourg, Luxembourg.
Orthop Traumatol Surg Res. 2020 Apr;106(2):335-339. doi: 10.1016/j.otsr.2020.01.002. Epub 2020 Mar 18.
The homodigital antegrade island flap pedicled on the proper palmar digital artery is very useful for covering fingertip defects. However, it has its drawbacks, such as the risk of stiffness due to retractile scars and the need for extensive dissection with long-lasting dysesthesia in some cases. In clinical studies, expanding the skin paddle with V-shaped incisions increases the flap's advancement. We wanted to know whether making these V incisions for paddle expansion would make dissection on the volar side of the proximal interphalangeal joint unnecessary.
A cadaver study was performed with four fresh-frozen upper limbs. Sequential dissection was carried out on 32 flaps, allowing us to compare the advancement obtained and the area of the flap's paddle between each step.
Crossing the palmar crease of the proximal interphalangeal joint provides only 2mm advancement of the homodigital antegrade flap. Adding one or two V-shaped incisions in the flap with limited dissection provides additional advancement of 4.1mm (p<0.05) and 6.9mm (p<0.05) relative to the standard flap.
Our study shows the possibility of increasing the homodigital antegrade flap's advancement - without having to extend the dissection proximally to the PIP joint - by making V-shaped incisions in the paddle. Based on our findings, we have proposed a new flap dissection sequence.
以固有掌侧指动脉为蒂的同指指动脉逆行岛状皮瓣对于覆盖指尖缺损非常有用。然而，它也有一些缺点，例如由于收缩性瘢痕导致的僵硬风险，以及在某些情况下需要广泛解剖和持久的感觉异常。在临床研究中，通过 V 形切口扩展皮瓣可以增加皮瓣的推进。我们想知道，为了皮瓣扩张而制作这些 V 形切口是否会使近节指间关节掌侧的解剖变得不必要。
对 4 个新鲜冷冻的上肢进行了尸体研究。对 32 个皮瓣进行了连续解剖，使我们能够比较每个步骤获得的推进程度和皮瓣桨叶的面积。
穿过近节指间关节的掌侧折痕只能为同指指动脉逆行皮瓣提供 2mm 的推进。在皮瓣上进行有限的解剖，并增加一个或两个 V 形切口，可以提供 4.1mm（p<0.05）和 6.9mm（p<0.05）的额外推进。
我们的研究表明，通过在桨叶上制作 V 形切口，可以增加同指指动脉逆行皮瓣的推进，而无需将解剖向上延伸至近节指间关节。基于我们的发现，我们提出了一种新的皮瓣解剖顺序。
