Article
Anatomical study of dorsal hand vascular network and clinical application of a new multiple intermetacarpal perforators flap
Search Medline for
Authors
-
Regina Sonda
- University of Padua, Padova, Italy
-
Andrea Monticelli
- University of Padua, Cherasco, Italy
-
Diego Faccio
- University of Padua, Sovizzo, Italy
-
Franco Bassetto
- University of Padua, Padova, Italy
-
Cesare Tiengo
- University of Padua, Padova, Italy
| Published: | February 6, 2020 |
|---|
Outline
Text
Objectives/Interrogation: The reconstruction of deep defects of dorsal long fingers continue to remain a chellenge for the hand surgeon. We investigated the anatomical basis of dorsal hand vascular network to perform a new wide turnover flap.
Methods: In ten fresh frozen upper limbs, injected with acrylic resin, the dorsal surface of hand was dissected. The intermetacarpal spaces and long fingers were evalueted for the charateristic (number, site, interval of origin and course) of dorso-palmar perforators. Wide perforator flap, based on multiple intermetacarpal distal perforators, was used in five patients for the soft tissue reconstruction of multiple dorsal long fingers.
Results and Conclusions: The mean number of perforator vessels of intermetacarpal space was 3.5, mainly septal-type. Proximally to juncturae tendinorum, the vessels were less numerous. The average distance between the more distal intermetacarpal perforator called Quaba perforator and the metacarpophalangeal joint was 1,15 cm (DS 0,58), between Quaba's and the commissural artery was 1,61 cm (DS 0,66). Proximally to Quaba, costant perforators have been encountered at a mean distance of 28 mm, 37.84 mm, 46.42 mm, 45.5 mm. In long fingers,the mean number of branches for the dorsal cutaneous network was 9 (range 5-15) arising from the proper digital artery. There were not simmetry between radial-ulnar sides, or opposite side of a interdigital-space. In 5 patients a multi-perforator flap, based on distal perforator vessels, has been used to cover the dorsal surface of multiple long fingers. A good aesthetic and clinical result has been achieved at 6 months of follow-up.
The perforator arteries network arising from intermetacarpal arteries, allow us to perform a distally based 4 multi-perforator flaps of entire subcutaneous surface of the dorsum to obviate to a microsurgical flap reconstruction. This new flap was then mobilize as a turn-over flap to cover the long fingers and then skin grafted. This autologous-functional reconstruction of all involved fingers allows an early and intense rehabilitation to achieve a better recovery. Subcutaneous surface guarantees tendons and joints gliding, with minimal donor site morbidity. Anatomical knowledge achieved, showed a reliable vascular network, able to support this wide adipo-fascial flap.
