From Hand and Foot Surgery, Tianjin Union Medical Center.
Reparative and Reconstructive Surgery, Shandong Public Health Clinical Center, Shandong Provincial Hospital.
Plast Reconstr Surg. 2023 Dec 1;152(6):1063e-1071e. doi: 10.1097/PRS.0000000000010514. Epub 2023 Apr 20.
This study aimed to introduce reconstruction of thumb defects using the second dorsal metacarpal artery (DMA) flap with two pivot points.
A retrospective study was conducted with 43 patients (group A) who underwent thumb reconstruction using the second DMA flap with two pivot points from July of 2012 to May of 2019. For comparison, the authors reviewed another cohort of 34 patients (group B) undergoing thumb reconstruction using the first DMA flap. Flap sensation and donor-site morbidity were assessed.
In group A, the mean two-point discrimination was 8.7 mm (range, 6 to 12 mm) and 9.7 mm (range, 7 to 12 mm) on the innervated and noninnervated flaps at the final follow-up, with a significant difference ( P = 0.012). In group B, the mean two-point discrimination of the flaps was 7.4 mm (range, 6 to 10 mm). By comparison, group B presented better discriminatory sensation than innervated flaps with double pivot points ( P = 0.002). Based on the visual analogue scale score, the mean score of scar pain and appearance of the donor site were 0.1 (range, 0 to 3) and 0.4 (range, 0 to 2) in group A, and 0.5 (range, 0 to 3) and 1.0 (range, 0 to 4) in group B. By comparison, group A presented lower incidence of scar pain ( P = 0.020) and better appearance of the donor site ( P = 0.019).
The second DMA flap with two pivot points has a long vascular pedicle, which allows the flap to repair thumb defects. It is associated with low donor-site morbidity but suboptimal sensory recovery.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
本研究旨在介绍使用具有两个旋转点的第二掌背动脉（DMA）皮瓣重建拇指缺损。
回顾性研究分析了 2012 年 7 月至 2019 年 5 月期间采用具有两个旋转点的第二 DMA 皮瓣进行拇指重建的 43 例患者（A 组）。为了进行比较，作者回顾性分析了另一组采用第一 DMA 皮瓣进行拇指重建的 34 例患者（B 组）。评估了皮瓣感觉和供区并发症。
A 组中，受神经支配和未受神经支配皮瓣的最终随访时两点辨别觉分别为 8.7mm（范围 6-12mm）和 9.7mm（范围 7-12mm），差异有统计学意义（P=0.012）。B 组皮瓣的两点辨别觉平均值为 7.4mm（范围 6-10mm）。相比之下，B 组的感觉优于具有双旋转点的受神经支配皮瓣（P=0.002）。根据视觉模拟评分，A 组供区瘢痕疼痛和外观的平均评分为 0.1（范围 0-3）和 0.4（范围 0-2），B 组为 0.5（范围 0-3）和 1.0（范围 0-4）。相比之下，A 组供区瘢痕疼痛发生率较低（P=0.020），外观较好（P=0.019）。
具有两个旋转点的第二 DMA 皮瓣具有较长的血管蒂，可修复拇指缺损。它与供区并发症发生率低有关，但感觉恢复不理想。
临床问题/证据水平：治疗性，III 级。
