Department of Orthopedic Surgery, Kurashiki Central Hospital, Kurashiki, Japan.
Department of Orthopedic Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
J Plast Reconstr Aesthet Surg. 2022 Sep;75(9):3226-3233. doi: 10.1016/j.bjps.2022.04.092. Epub 2022 May 2.
Radial artery superficial palmar branch harvesting is technically challenging, especially for inexperienced hand surgeons. The short pedicle and a damaged recipient digital artery require proximal digital artery dissection and relatively long pedicles. Herein, we describe a facilitated flap elevation technique and its application in various cases. From 2013 to 2021, 10 patients with finger injuries received radial artery superficial palmar flaps. We assessed flap survival, sizes, complications, two-point discrimination, and the Semmes-Weinstein monofilament test results. The main shortcoming of a radial artery superficial palmar flap is its short pedicle. Therefore, we developed a long skin flap design in the long axis direction, and the accompanying vein was dissected proximally to the radial artery to obtain a long pedicle. All flaps survived. The median flap dimension was 5.0 × 2.2 cm (maximum size: 6.0 × 2.0 + 5.0 × 2.0 cm [for a bilobed flap]). While nerve reconstruction was performed in one patient, all patients had preserved sensation. A sufficiently long pedicle can be obtained by dissecting the accompanying vein proximally to the radial artery. Perforators found in the skin around the scaphoid tubercle in all cases suggest value in including this region in flap design. To obtain a longer pedicle, the flap was developed with the long-skin design in the long-axis direction. Although the accompanying vein is usually thin and difficult to anastomose with the finger vein, its proximal dissection led to the accompanying vein of the radial artery that facilitated the harvesting of a sufficiently long vein.
桡动脉掌浅支的采集技术难度较大，尤其是对手外科经验不足的医生来说。短蒂和受损的受区指动脉需要近端指动脉解剖和相对较长的蒂。在此，我们描述了一种便于皮瓣掀起的技术及其在各种情况下的应用。2013 年至 2021 年，10 例手指损伤患者接受了桡动脉掌浅支皮瓣修复。我们评估了皮瓣的成活率、大小、并发症、两点辨别觉和 Semmes-Weinstein 单丝试验结果。桡动脉掌浅支皮瓣的主要缺点是蒂短。因此，我们设计了一个长皮瓣，沿长轴方向，伴行静脉近端解剖至桡动脉，以获得长蒂。所有皮瓣均存活。皮瓣的平均尺寸为 5.0×2.2cm（最大尺寸：6.0×2.0+5.0×2.0cm[双叶瓣]）。1 例患者行神经重建，所有患者均保留感觉。通过解剖伴行静脉近端至桡动脉，可获得足够长的蒂。所有病例在手舟骨结节周围皮肤均发现穿支，提示在皮瓣设计中包含该区域有价值。为了获得更长的蒂，皮瓣沿长轴方向设计为长皮瓣。尽管伴行静脉通常较细，与指静脉吻合困难，但近端解剖可导致桡动脉伴行静脉，便于采集足够长的静脉。
