Department of Plastic and Reconstructive Surgery, Radboud University Medical Center Nijmegen (Radboudumc), Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands.
Department of Plastic and Reconstructive Surgery, Radboud University Medical Center Nijmegen (Radboudumc), Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands.
J Plast Reconstr Aesthet Surg. 2023 Aug;83:141-147. doi: 10.1016/j.bjps.2023.04.040. Epub 2023 Apr 25.
Extended soft tissue defects of the fingers are often challenging to treat, and therefore, we performed cadaver dissections to elucidate the anatomic relationship between dorsal arterial perforators of the distal upper extremities to support the development of new local flaps.
Ten fixated cadaveric distal dorsal lower forearms were dissected to their arterial perforators down to 0.1 mm diameter in size with identification of their relationship.
Dorsal distal fascia piercing perforators of the lower forearm come in two distinct rows, radial and ulnar, of the fourth extensor compartment. These were interconnected by subfascial axial arteries in line. The most proximal perforator is usually located 8-10 cm from the dorsal wrist, the most distal about 1-2 cm, and on average, only three subcutaneous bridging vessels connect both axial systems. The number of less reliable subcutaneous arterial connecting vessels between the dorsal wrist and forearm is also fairly limited to only one or two. More constant bridging arteries interconnect at the level of the dorsal retinaculum between the axial systems of the hand and lower forearm. At the level of the dorsum of the hand perforators reaching the skin, they interconnect in an arcuate fashion. This unique distribution pattern could be used for freestyle perforator propellor flaps of the hand, as we demonstrated in a case directly derived from our recent research.
In our opinion, a super-extended perforator flap should be possible with the inclusion of the bridging arteries in flap design at the level of the dorsal retinaculum.
手指的广泛软组织缺损往往难以治疗，因此，我们进行了尸体解剖，以阐明上肢远端背侧动脉穿支与新局部皮瓣之间的解剖关系。
解剖 10 个固定的尸体远侧下前臂，直到 0.1mm 直径的大小，识别其关系。
下前臂第四伸肌间隔的背侧远侧筋膜穿支有两排明显的桡侧和尺侧，它们通过筋膜下的轴向动脉成直线连接。最接近近侧的穿支通常位于背侧腕部 8-10cm 处，最接近远侧的穿支约 1-2cm，平均只有三根皮下桥接血管连接两个轴向系统。连接背侧腕部和前臂之间的不太可靠的皮下动脉连接血管的数量也相当有限，只有一到两条。更恒定的桥接动脉在手和下前臂的轴向系统之间的背侧支持带水平相互连接。在手背的穿支到达皮肤的水平，它们以弧形相互连接。这种独特的分布模式可用于我们最近研究中直接衍生的手部游离穿支螺旋桨皮瓣。
我们认为，通过在背侧支持带水平的桥接血管纳入皮瓣设计，超广泛的穿支皮瓣是可行的。
