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王 辉, 王 海, 秦 浩, 郝 睿, 马 铁, 刘 英, 王 斌. [Clinical application of perforator-based propeller flaps in repair of hand wound]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:1016-1021. [PMID: 39175326 PMCID: PMC11335591 DOI: 10.7507/1002-1892.202404006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/09/2024] [Indexed: 08/24/2024]
Abstract
Objective To investigate the effectiveness of the perforator-based propeller flaps (PPFs) based on digital artery (DA) and dorsal metacarpal artery (DMA) in repairing hand wounds. Methods The clinical data of 45 patients with hand wounds between January 2018 and March 2023 were retrospectively analyzed. There were 27 males and 18 females with an average age of 41.2 years (range, 14-72 years). The causes of injury included twist injury in 15 cases, crush injury in 19 cases, and cut injury in 11 cases. The injured parts included 32 cases of digits, 10 cases of dorsal hand, and 3 cases of palmar hand, all of which had tendon, joint, and bone exposure. The time from injury to operation ranged from 2 to 8 hours (mean, 4.3 hours). The wound sizes after debridement ranged from 1.8 cm×1.0 cm to 5.0 cm×3.5 cm. Twenty-eight cases were repaired by the PPFs based on DA and 17 cases were repaired by the PPFs based on DMA. The flap size ranged from 2.5 cm×1.1 cm to 8.5 cm×4.0 cm. The defects of the donor sites in 14 patients were closed directly and the defects in the left 31 patients were resurfaced with free full-thickness skin graft from the proximal medial forearm. Results All the flaps survived after operation. Two cases of the PPF based on DA and 1 case of the PPF based on DMA underwent partially blisters at the distal end and healed after dressing change. The incisions in the donor site healed by first intention and the skin grafts survived. All patients were followed up 10-33 months, with a mean of 15.4 months. At last follow-up, the static two-point discrimination of the PPFs based on DA and DMA were 4-14 mm and 8-20 mm with the averages of 8.1 mm and 13.3 mm, respectively. According to the Michigan Hand Outcomes Questionnaire, 20 patients were very satisfied with the appearance of the PPF based on DA and 8 patients were satisfied; 8 patients were very satisfied with the appearance of the PPF based on DMA and 9 patients were satisfied. Based on the Vancouver Scar Scale (VSS), the appearance scores of the donor site of the PPFs based on DA and DMA were 2-7 and 4-9, with the averages of 4.2 and 6.1, respectively. Conclusion The two kinds of PPFs are reliable in blood supply and easy to harvest, which provide a good method for emergency repair of small and medium area wounds in the hand.
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Affiliation(s)
- 辉 王
- 唐山市第二医院手外科(河北唐山 063000)Department of Hand Surgery, Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China
| | - 海峰 王
- 唐山市第二医院手外科(河北唐山 063000)Department of Hand Surgery, Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China
| | - 浩宇 秦
- 唐山市第二医院手外科(河北唐山 063000)Department of Hand Surgery, Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China
| | - 睿峥 郝
- 唐山市第二医院手外科(河北唐山 063000)Department of Hand Surgery, Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China
| | - 铁鹏 马
- 唐山市第二医院手外科(河北唐山 063000)Department of Hand Surgery, Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China
| | - 英 刘
- 唐山市第二医院手外科(河北唐山 063000)Department of Hand Surgery, Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China
| | - 斌 王
- 唐山市第二医院手外科(河北唐山 063000)Department of Hand Surgery, Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China
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Bovill J, Huffman S, Cach G, Haffner Z, Deldar R, Abu El Hawa AA, Sgromolo N, Giladi AM. Propeller Perforator Flaps Used for Hand and Digit Reconstruction: A Systematic Review. J Hand Microsurg 2024; 16:100035. [PMID: 38855530 PMCID: PMC11144646 DOI: 10.1055/s-0043-1768482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Background Propeller perforator flaps (PPFs) have increased in popularity due to the freedom in design and ability to cover a variety of defects without sacrificing the major vessels. Present reports of PPFs for upper limb reconstruction have not provided guidance for hand reconstruction, specifically. This study aims to review the current literature and evaluate techniques for use of PPFs in hand reconstruction. Methods A comprehensive literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for articles published from 1991 to 2021. The database search was queried for records using appropriate Medical Subject Headings (MeSH) terms. Studies reporting PPFs were limited to English language and excluded lower extremity or upper extremity reconstruction not specific to defects in the hand or digits. Study characteristics, patient demographics, indications, preoperative testing, flap characteristics, flap survival, and complication rates were collected. Results Out of the initial 1,348 citations yielded, 71 underwent full-text review. Ultimately, 25 unique citations were included encompassing 12 retrospective reviews (48%), 3 prospective cohort studies (10%), and 10 case series (40%). In review, 525 patients underwent reconstruction with a total of 613 propeller flaps performed to repair defects of the hand, digits, or both with use of 18 unique flap types. Overall flap survival was 97.8%. Acute wounds accounted for 72.9% of performed reconstructions. The mean flap coverage was 14.7 cm2. Complications occurred in 19.8% of cases, with venous congestion and partial flap necrosis occurring in 5.5 and 6.5% of cases, respectively, leading to a flap failure rate of 2.1%. Conclusion PPFs are a reliable option for hand or digital reconstruction, allowing surgeons to cover a variety of defects without sacrificing local vasculature. Despite nearly a 20% reported complication rate, nearly all flaps with venous congestion and partial flap necrosis included in these articles resolved without the need for secondary intervention, retaining an excellent overall flap survival.
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Affiliation(s)
- John Bovill
- Georgetown University School of Medicine, Washington, Dist. of Columbia, United States
| | - Samuel Huffman
- Georgetown University School of Medicine, Washington, Dist. of Columbia, United States
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, Dist. of Columbia, United States
| | - Gina Cach
- Georgetown University School of Medicine, Washington, Dist. of Columbia, United States
| | - Zoe Haffner
- Georgetown University School of Medicine, Washington, Dist. of Columbia, United States
| | - Romina Deldar
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, Dist. of Columbia, United States
| | - Areeg A. Abu El Hawa
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Nicole Sgromolo
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland, United States
| | - Aviram M. Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland, United States
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Jayachandiran AP, Rajendran S, Mahipathy SRV, Durairaj AR, Sundaramurthy N, Ananthappan M. Applications and Reliability of Dorsal Metacarpal Artery Perforator Flap. Indian J Plast Surg 2023; 56:519-525. [PMID: 38105876 PMCID: PMC10721361 DOI: 10.1055/s-0043-1773771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Dorsal metacarpal artery perforator flap (DMAP), first described by Quaba and Davison, is a useful tool in the armamentarium of plastic surgeons. It provides like for like tissue for the reconstruction of dorsal finger defects. It is a simple and relatively easy flap to harvest with minimal donor site morbidity. In this case series, we present our experience, applications, and surgical technique of flap harvesting.
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Affiliation(s)
- Anand Prasath Jayachandiran
- Department of Plastic and Reconstructive Surgery, Saveetha Medical College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Thandalam, Tamil Nadu, India
| | - Suresh Rajendran
- Department of Plastic and Reconstructive Surgery, Saveetha Medical College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Thandalam, Tamil Nadu, India
| | - Surya Rao Venkata Mahipathy
- Department of Plastic and Reconstructive Surgery, Saveetha Medical College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Thandalam, Tamil Nadu, India
| | - Alagar Raja Durairaj
- Department of Plastic and Reconstructive Surgery, Saveetha Medical College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Thandalam, Tamil Nadu, India
| | - Narayanamurthy Sundaramurthy
- Department of Plastic and Reconstructive Surgery, Saveetha Medical College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Thandalam, Tamil Nadu, India
| | - Manoj Ananthappan
- Department of Plastic and Reconstructive Surgery, Saveetha Medical College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Thandalam, Tamil Nadu, India
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Liu B, Pan D, Gao Z, Duan P, Ou Q. Double-pivot proper digital artery perforator flap for fingertip reconstruction. J Orthop Surg Res 2023; 18:737. [PMID: 37770926 PMCID: PMC10540400 DOI: 10.1186/s13018-023-04231-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/22/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Dorsal flap based on proper digital artery perforator has been commonly used in wound coverage of fingertip; yet a small diameter and short length poses a risk of pedicle kinking or occlusion. The present study aims to present our preliminary results of using a double-pivot perforator flap based on the end dorsal branch of proper digital artery to repair finger pulp defect. METHODS We designed a double-pivot flap based on the end-dorsal perforator branch of proper digital artery, raised from the dorsal aspect of the middle phalanx, with inclusion of both the perforator and a section of the trunk of the artery. This modified procedure forms a pedicle with a larger diameter and length than traditional designs. Twelve patients (12 fingers) each with a soft-tissue defect of the fingertip were successfully treated and followed up in this retrospective study. RESULTS All the flaps survived without showing any signs of necrosis; three cases presented with transient venous flow disorder, these self-resolving without requiring any additional treatment. At final follow-up (12-33 months, mean 20 months), mean static two-point discrimination on the flap was 7.0 mm (range, 6-9). CONCLUSION The double-pivot proper digital artery flap serves as a reliable option in fingertip reconstruction offering added benefits of having greater rotation flexibility, a lower risk of vessel kinking or occlusion, and good recovery of cutaneous sensation.
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Affiliation(s)
- Benquan Liu
- Department of Hand Surgery, Zhoukou Orthopedic Hospital, Taihao Road, Chuanhui District, Zhoukou City, Henan, China
| | - Ding Pan
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, No.87 XiangYa Road, Kaifu District, Changsha, Hunan, China
| | - Zhiyu Gao
- Department of Hand Surgery, Zhoukou Orthopedic Hospital, Taihao Road, Chuanhui District, Zhoukou City, Henan, China
| | - Pengfei Duan
- Department of Hand Surgery, Zhoukou Orthopedic Hospital, Taihao Road, Chuanhui District, Zhoukou City, Henan, China
| | - Qifeng Ou
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, No.87 XiangYa Road, Kaifu District, Changsha, Hunan, China.
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Comparison of reading man flap and skin grafting for closure of resultant donor defects in homodigital reverse flow flaps. J Plast Reconstr Aesthet Surg 2023; 77:63-67. [PMID: 36549124 DOI: 10.1016/j.bjps.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The reading man procedure is a valuable treatment option for circular defects of different parts of the body. The aim of this study was to compare reading man procedure and skin grafting for coverage of resultant donor defects in homodigital reverse flow flaps. METHODS From January 2018 to October 2020, 38 patients underwent fingertip reconstruction using homodigital reverse flow flaps. The donor sites were resurfaced with full-thickness skin grafts in 20 patients and with reading man flaps in 18 patients. Flap survival, postoperative complications, operative time for closure of donor site, return work time, range of motion of the injured fingers, static two-point discrimination, and aesthetic results were evaluated. RESULTS All the outcomes, including flap survival, postoperative complications, operative time for closure of donor site, return work time, range of motion of the injured fingers, static two-point discrimination, and aesthetic results, were similar between the two groups. No patients complained of cold intolerance or hypersensitivity. CONCLUSION The reading man flap is useful and reliable for covering resultant donor defects in homodigital reverse flow flaps. The functional and aesthetic outcomes in both groups are similar.
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Khan WU, Appukuttan A, Loh CYY. Homodigital Pedicled Digital Artery Perforator flaps for fingertip reconstruction - a review of flap options. JPRAS Open 2022; 34:199-218. [DOI: 10.1016/j.jpra.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
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Xu X, Wang C, Chen Z, Li J. Medial plantar artery perforator (MPAP) flap is an ideal option for reconstruction of complex soft tissue defect in the finger: Clinical experience from 11 cases. Front Surg 2022; 9:934173. [PMID: 35959121 PMCID: PMC9360503 DOI: 10.3389/fsurg.2022.934173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionSoft tissue defects of fingers are common in reconstructive plastic surgery, and reconstruction of the defects remains challenging for plastic surgeons. In our study, we reported our experience in finger reconstruction with a medial plantar artery perforator (MPAP) flap, especially using a lobulated MPAP flap for the complex multifinger soft defect.Patients and methodsFrom the period April 2012 to October 2018, 11 patients (9 males and 2 females) with an average age of 44 years old (ranging from 11 to 58) received finger reconstruction with a free MPAP flap. In total, 11 flaps (8 single-lobulated flaps and 3 two-lobulated flaps) were raised from the ipsilateral or contralateral instep area. Trauma and scar contracture caused hand soft tissue loss in all cases.ResultsThe sizes of the flaps ranged from 2×3 to 5×7.5 cm2. All flaps survived intact with no complications. One donor site was closed primarily, and other donor sites were covered with a full-thickness skin graft. The mean follow-up time was 6 months (ranging from 3 to 8 months). During the follow-up period, the patients were satisfied with their appearance without any traces of flap plastic surgery.ConclusionThe MPAP flap is a reliable and acceptable option for the reconstruction of complex soft tissue defects in the finger. Depending on the two branches of the medial plantar artery, the use of the lobulated MPAP flap holds promise in the treatment of multifinger soft tissue defects.
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Bordianu A, Leoveanu FI. Hand soft tissue reconstruction with dorsal metacarpal artery perforator (Quaba) flap. J Med Life 2022; 14:731-736. [PMID: 35027979 PMCID: PMC8742893 DOI: 10.25122/jml-2021-0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
Hand soft tissue defects after trauma injuries or tumor excision are challenging for the plastic surgeon, regardless of the patient's age, gender, or ethnicity. Current surgical protocols suggest protecting the main arteries by using local or free perforator flaps. This article describes the use of local perforator flaps to resurface soft tissue defects with exposed tendons, nerves, arteries and/or bones to obtain the best mobility of the flexion creases without sacrificing the main artery. We present the use of the dorsal metacarpal artery perforator (Quaba) flap in two cases, showing different types of pathology that could benefit from this method. The first case is a 43-year-old male patient, known with psoriasis, who suffered a home accident with a chainsaw. The second case is a 35-year-old woman with a round, mobile skin tumor located on the volar surface of the metacarpophalangeal joint. The patients were discharged from the hospital the next day postoperative. Both patients reported a slight bulkiness of the flap without affecting the functional outcome, preserving full mobility of the fingers. The Quaba flap is a distally based perforator axial flap suitable for soft tissue defects reconstructions, safe and easy to use, with minimal donor site morbidity. Slight bulkiness could affect the aesthetics of the hand.
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Affiliation(s)
- Anca Bordianu
- Department of Plastic Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Plastic Surgery, Bagdasar-Arseni Emergency Hospital, Bucharest, Romania
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Kwon HJ, Yoon S, Han HH, Moon SH. Partial second-toe pulp free flap for fingertip reconstruction: Experience and surgical tips to minimize complications. Microsurgery 2021; 41:629-636. [PMID: 34480508 DOI: 10.1002/micr.30804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/28/2021] [Accepted: 08/25/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Traumatic fingertip injury is a common hand injury and various methods are available to address them. The partial second-toe pulp (PSTP) free flap is useful because of the similarity in shape, texture, and sensation to the fingertips. However, there may be many difficulties during surgery. The purpose of this report is to make the surgery easier and minimize complications by sharing the surgical tips of the authors obtained through many experiences. PATIENTS AND METHODS Thirty patients who underwent PSTP free flap due to trauma were reviewed retrospectively from February 2015 to June 2018. The average age of the patients was 49.4 years. Seventeen were injured on the right side and 13 were on the left side. After removal of the injured tissue, a teardrop-shaped flap was harvested from the medial side of the second toe. When inset, skin graft or vein graft was performed if necessary. When primary closure of the donor site was difficult, skin graft was performed (n = 21). The factors noted during surgery were analyzed. RESULTS The flap size was 2.39 (range: 1.5-5) x 1.29 (range: 1-1.8) cm2 . All flaps survived. Venous congestion was found in two patients, neuroma was found in one patient, and partial necrosis was found in two patients; all recovered with conservative care. The mean follow up periods was 5.79 (range: 2-18) months. None of the patients had functional impairment. CONCLUSION Successful reconstruction and enhanced functional and cosmetic effects can be achieved using surgical tips.
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Affiliation(s)
- Hyo Jeong Kwon
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sungyeon Yoon
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyun Ho Han
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan School of Medicine, Seoul, South Korea
| | - Suk-Ho Moon
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Chen J, Zhong Chen Q. Problems with dorsal digital artery perforator flaps for fingertip repair. J Hand Surg Eur Vol 2021; 46:323-324. [PMID: 33601970 DOI: 10.1177/1753193421991957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Jing Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Qing Zhong Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Tos P, Crosio A, Pugliese P, Georgescu AV. Propeller Flaps for Hand and Digit Reconstruction. Semin Plast Surg 2020; 34:192-199. [PMID: 33041690 DOI: 10.1055/s-0040-1715155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The reconstruction of soft tissue defects of the hand, as seen often after trauma or tumor excision, is a challenge due to the great differentiation of tissues depending on the hand area involved. The classical intrinsic "workhorse flaps" of the hand are associated with a significant donor-site morbidity. Capturing perforator vessels in discrete donor areas can reduce the amount of soft tissue that has to be dissected and included in what now would be a perforator flap, while also insuring robust vascularization of those transferred tissues. Moreover, the presence of perforator vessels both on the dorsal and volar sides of the hand allows harvest of perforator flaps that will respect the like-with-like principle by maintaining the main characteristics of volar and dorsal skin as desired. However, the dissection of these flaps, especially those based on volar palmar and digital perforators, still requires microsurgical skills to preserve the fine vascularization of these flaps. These small flaps are also amenable for application of the propeller flap concept. This is an especially valuable means for preserving the length of an amputated finger where bone is exposed by using more proximal uninjured tissues. Although in general only a short dissection is required to raise a propeller flap in this region, most often the donor site will have to be closed by a skin graft.
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Affiliation(s)
- Pierluigi Tos
- Hand Surgery and Reconstructive Microsurgery Department, ASST Gaetano Pini-CTO, Milan, Italy
| | - Alessandro Crosio
- Hand Surgery and Reconstructive Microsurgery Department, ASST Gaetano Pini-CTO, Milan, Italy
| | - Pierfrancesco Pugliese
- Plastic and Reconstructive Surgery Department, AOU Policlinico Paolo Giaccone, Palermo, Italy
| | - Alexandru Valentin Georgescu
- Plastic Surgery and Reconstructive Microsurgery Department, Clinical Hospital of Rehabilitation, University of Medicine Iuliu Hatieganu, Cluj-Napoca, Romania
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Pan J, Li M, Huang Y, Dong J, Wang X, Wang L. Pure perforator free sensory proximal ulnar artery perforator flap for resurfacing hand defects. J Int Med Res 2020; 48:300060520922396. [PMID: 32459118 PMCID: PMC7278109 DOI: 10.1177/0300060520922396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This prospective study was performed to investigate the distribution of
proximal ulnar artery perforating vessels through three-dimensional blood
vessel reconstruction and examine the presence and consistency of the
perforating vessels intraoperatively. Methods For anatomical guidance, three-dimensional blood vessel reconstruction was
performed to determine the consistent presence of perforating vessels in the
proximal ulnar artery. A free proximal ulnar artery perforator flap was then
transferred in 17 patients to resurface skin defects on the hands. Color
Doppler ultrasound was used to identify and mark the perforating vessels.
Intraoperative evaluation was conducted to check for anastomosis of the
perforating vessels at the marked sites and assess the vessel anastomosis
conditions. Results No vascular crisis, flap necrosis, or wound infection occurred after surgery
in 15 patients. Postoperative follow-up was conducted for 6 to 36 months.
The appearance of the flap was satisfactory, the texture of the flap was
soft, sensation was well restored, and hand function was not limited. The
mean two-point discrimination of the flap was 7.6 ± 2.2 mm. Conclusions Free sensory proximal ulnar artery perforator flap transfer is a safe and
reliable surgical technique with respect to restoration of both the
appearance and sensory function of the hand.
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Affiliation(s)
- Jiadong Pan
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Miaozhong Li
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Yaopeng Huang
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Jianghui Dong
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, China.,UniSA Clinical & Health Sciences and UniSA Cancer Research Institute, University of South Australia, Adelaide, SA, Australia
| | - Xin Wang
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Liping Wang
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, China.,UniSA Clinical & Health Sciences and UniSA Cancer Research Institute, University of South Australia, Adelaide, SA, Australia
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