From the Department of Hand and Foot Surgery, Taizhou Hospital of Zhejiang Province, affiliated with Wenzhou Medical University.
Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University College of Medicine.
Plast Reconstr Surg. 2024 Jun 1;153(6):1348-1357. doi: 10.1097/PRS.0000000000010909. Epub 2023 Jul 4.
Flaps based on the medial plantar artery (MPA) accomplish favorable surgical outcomes in palmar resurfacing because of their outstanding texture, pliability, and contour, but primary closure cannot be achieved at the donor site when the flap is designed to be relatively large. In this study, the kiss technique was used for the reconstruction of extensive palmar defects, which minimized donor-site morbidity.
A modified flap surgical strategy was systemically developed based on the perforator distribution of the MPA through a cadaver study. Two or three narrow, small skin paddles based on the MPA were raised and resembled at the recipient site as a larger flap. Static two-point discrimination, hypersensitivity and range of motion, QuickDASH, gait, and patient satisfaction were evaluated 6 months to 12 months after the operation.
From June of 2015 to July of 2021, 20 cases of reconstruction using the MPA perforator kiss flap were performed for the resurfacing of palmar skin defects. All flaps survived uneventfully, with coverage matching the texture and color of the recipients, except one flap that exhibited venous congestion and recovered after revision. Twelve flaps (60%) were double-paddled, and eight flaps (40%) were triple-paddled, with a resurfacing area of 27.19 cm 2 and 41.1 cm 2 , respectively. All donor sites achieved primary closure without major complications.
Versatile kiss flap combinations were developed based on further understanding of the MPA system. Durable and pliable characteristics of the MPA perforator flap provide excellent reconstruction for extensive palmar defects while minimizing donor-site complications.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
基于足底内侧动脉（MPA）的皮瓣在手掌表面重建中取得了良好的手术效果，因为它们具有出色的质地、柔韧性和轮廓，但当皮瓣设计相对较大时，无法在供体部位实现一期闭合。在这项研究中，使用吻合法进行了广泛的手掌缺损重建，从而将供体部位的发病率降到最低。
通过尸体研究，系统地基于 MPA 的穿支分布，制定了一种改良的皮瓣手术策略。基于 MPA 提出了两个或三个狭窄的小皮瓣，并在受区吻合形成较大的皮瓣。术后 6 至 12 个月，评估静态两点辨别觉、超敏反应和活动范围、QuickDASH、步态和患者满意度。
2015 年 6 月至 2021 年 7 月，采用 MPA 穿支吻合法对 20 例手掌皮肤缺损患者进行了重建。所有皮瓣均顺利存活，覆盖范围与受区的质地和颜色相匹配，除 1 例出现静脉淤血，经修正后恢复。12 个皮瓣（60%）为双叶皮瓣，8 个皮瓣（40%）为三叶皮瓣，分别覆盖 27.19 cm2和 41.1 cm2的区域。所有供体部位均实现了一期闭合，无重大并发症。
通过进一步了解 MPA 系统，开发了灵活的吻合法组合。MPA 穿支皮瓣的耐用性和柔韧性为广泛的手掌缺损提供了极好的重建，同时最大限度地减少了供体部位的并发症。
临床问题/证据水平：治疗，IV。
