Wolf-Mandroux A, Detammaecker R, De Almeida Y K, Krebs M, Dautel G, Athlani L
Service de chirurgie de la main - chirurgie plastique et reconstructrice de l'appareil locomoteur, centre chirurgical Emile-Gallé, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France.
Département d'anatomie, faculté de médecine, université de Lorraine, 9, avenue de la Forêt de Haye, 54500 Vandœuvre-lès-Nancy, France.
Hand Surg Rehabil. 2020 Oct;39(5):431-436. doi: 10.1016/j.hansur.2020.03.008. Epub 2020 May 11.
The pedicled flap from the first dorsal branch of the proper palmar digital artery (FBPPDA) of the fingers is an option for reconstructing digital skin defects. It has the advantage of being innervated by the dorsal branch of the proper palmar digital nerve (DBPPDN) associated with the artery. However, no studies on the anatomical variations of the neurovascular pedicle have been performed yet. The objective of our study was to evaluate the anatomical variations in the neurovascular pedicle, determine its relationships with other anatomical structures, describe the dissection technique for the FBPPDA and explore potential indications. We conducted an anatomical study with eight upper limbs from fresh adult cadavers. Twenty-six fingers (6 index, 6 middle, 8 ring, 8 little) were dissected after intra-arterial silicone injection. We found a pedicle composed of the FBPPDA and the DBPPDN in all fingers. The artery arises an average 19mm from the bifurcation of the common palmar digital artery. The DBPPDN's configuration relative to the FBPPDA varied; in the main variant - found in 58% of cases - the nerve was superficial and proximal position to the artery. After its origin, the pedicle ran on the superficial aspect of the extensor hood along an oblique path from proximal to distal and from palmar to dorsal. Its path ended with its penetration into the skin paddle of the flap just upstream the proximal interphalangeal (PIP) joint. The skin paddle corresponded to the functional skin unit represented by the dorsal surface of the middle phalanx and that of the PIP joint. Its average length was 33mm (26-40) and its average width was 21mm (15-30). The arc of rotation was sufficient to reach homodigital and heterodigital cutaneous defects. Based on our findings, this flap is a reliable and reproducible option for finger skin defects. The size of its paddle and its innervation make it an interesting alternative to conventional flaps.
手指掌侧固有动脉第一背侧支带蒂皮瓣（FBPPDA）是修复手指皮肤缺损的一种选择。它的优势在于由与该动脉伴行的掌侧固有神经背侧支（DBPPDN）支配。然而，目前尚未有关于该神经血管蒂解剖变异的研究。本研究的目的是评估神经血管蒂的解剖变异，确定其与其他解剖结构的关系，描述FBPPDA的解剖技术并探索潜在适应证。我们对8具新鲜成人尸体的上肢进行了解剖学研究。在动脉内注入硅胶后，对26根手指（6根示指、6根中指、8根环指、8根小指）进行了解剖。我们发现所有手指均有由FBPPDA和DBPPDN组成的蒂。该动脉平均起自掌侧总动脉分叉处19mm远心端。DBPPDN相对于FBPPDA的形态各异；在主要变异类型中（58%的病例），神经位于动脉浅面且在近端。蒂在起始后，沿伸肌帽浅面从近端向远端、从掌侧向背侧呈斜行走行。其走行以在近端指间（PIP）关节上游穿入皮瓣的皮岛而告终。皮岛对应于以中节指骨背侧和PIP关节背侧为代表的功能皮肤单位。其平均长度为33mm（26 - 40），平均宽度为21mm（15 - 30）。旋转弧足以到达同指和异指皮肤缺损处。基于我们的研究结果，该皮瓣是修复手指皮肤缺损的一种可靠且可重复的选择。其皮岛大小及神经支配使其成为传统皮瓣的一个有吸引力的替代方案。
