CLINICAL APPLICATION OF MICRO TRANSVERSE FLAP PEDICLED WITH SUPERFICIAL PALMAR BRANCH OF RADIAL ARTERY FROM PALMAR WRIST TO REPAIR SKIN DEFECT OF FINGER_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Min ¹ , TIAN Dehu ² , SHAO Xinzhong ² , LI Dacun ¹ , LIU Jingda ¹ , ZHAO Liang ¹ , LI Hailei ¹ , WANG Xiaolei ¹ , ZHANG Wentong ¹ , LI Jianfeng ¹

1Department of Upper Limber Surgery, Beijing Shunyi Hospital of China Medical University, Beijing, 101300, P.R.China;;
2Department of Hand Surgery, the Third Affiliated Hospital of Hebei Medical University. Corresponding author: TIAN Dehu, E-mail: tiandehu899@sohu.com;

Corresponding author：

Keywords：

Micro transverse flap of palmar wrist; Superficial palmar branch of the radial artery; Finger; Wound repair

DOI：

10.7507/1002-1892.20130324

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Objective To investigate the clinical application of micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist to repair skin defect of finger. Methods Twenty-six cases (26 fingers) with skin defect of finger were repaired with micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist between December 2011 and February 2013. There were 20 males and 6 females with the average age of 31.5 years (range, 20-56 years). The causes of injury included cutting injury in 20 cases and crushing injury in 6 cases. The time from injury to admission was 1-5 hours with an average of 2 hours. Injured fingers included thumb in 6 cases, index finger in 6 cases, middle finger in 6 cases, ring finger in 4 cases, and little finger in 4 cases; the locations were the dorsal side of the finger in 6 cases, lateral side in 6 cases, and the volar of the finger tip in 14 cases; there were 4 cases on the proximal phalangeal skin, 8 cases on the middle phalangeal skin, and 14 cases on the distal phalangeal skin. The defect area ranged from 2.0 cm × 1.5 cm to 4.0 cm × 2.0 cm, and the flap area ranged from 2.5 cm × 2.0 cm to 4.5 cm × 2.5 cm. All the donor sites were directly sutured. Results The flaps of 25 cases survived well after operation, and wound healed by first intention； 1 case had partial necrosis and the wound had a scar healing by changing dressing. All cases were followed up 6-12 months (mean, 10 months). The color and appearance of the flaps were satisfactory with tender texture. The two-point discrimination of the flap was 5-8 mm (mean, 6.8 mm). The donor sites healed primarily without scar contracture and limitation of wrist flexion or extension. Conclusion The micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist is a good option to repair skin defect of finger. It has the advantages of hidden donor site, the same operative field, great comparability of flap and finger skin, and it can be used as a vascularized tendon or nerve graft.

Citation： ZHAO Min,TIAN Dehu,SHAO Xinzhong,LI Dacun,LIU Jingda,ZHAO Liang,LI Hailei,WANG Xiaolei,ZHANG Wentong,LI Jianfeng. CLINICAL APPLICATION OF MICRO TRANSVERSE FLAP PEDICLED WITH SUPERFICIAL PALMAR BRANCH OF RADIAL ARTERY FROM PALMAR WRIST TO REPAIR SKIN DEFECT OF FINGER. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(12): 1475-1479. doi: 10.7507/1002-1892.20130324 Copy

1.	Jihui JU, Liu Y, Hou R. Ulnar artery distal cutaneous descending branch as free flap in hand reconstruction. Injury, 2009, 40(12): 1320-1326.
2.	Gao W, Yan H, Li Z, et al. The free dorsoradial forearm perforator flap: anatomical study and clinical application in finger reconstruction. Ann Plast Surg, 2011, 66(1): 53-58.
3.	Chen C, Tang P, Zhang X. Sensory reconstruction of a finger pulp defect using a dorsal homodigital island flap. Plast Reconstr Surg, 2012, 130(5): 1077-1086.
4.	Takeishi M, Shinoda A, Sugiyama A, et al. Innervated reverse dorsal digital island flap for fingertip reconstruction. J Hand Surg (Am), 2006, 31(7): 1094-1099.
5.	李学渊, 王晓峰, 滕晓峰, 等. 游离腓动脉肌皮穿支皮瓣修复手部皮肤缺损. 中华手外科杂志, 2007, 23(4): 214-215.
6.	Sakai S. Free flap from the flexor aspect of the wrist for resurfacing defects of the hand and fingers. Plast Reconstr Surg, 2003, 111(4): 1412-1420.
7.	赵民, 田德虎, 邵新中, 等. 腕部掌侧桡动脉掌浅支横行微型皮瓣的解剖学研究. 中国修复重建外科杂志, 2013, 27(7): 864-868.
8.	Yang JW, Kim JS, Lee DC, et al. The radial artery superficial palmar branch flap: a modified free thenar flap with constant innervation. J Reconstr Microsurg, 2010, 26(8): 529-538.
9.	Sassu P, Lin CH, Lin YT, et al. Fourteen cases of free thenar flap: a rare indication in digital reconstruction. Ann Plast Surg, 2008, 60(3): 260-266.
10.	Kim KS, Kim ES, Hwang JH, et al. Thumb reconstruction using the radial midpalmar (perforator-based) island flap (distal thenar perforator-based island flap). Plast Reconstr Surg, 2010, 125(2): 601-608.
11.	Omokawa S, Tanaka Y, Ryu J, et al. Anatomical consideration of reverse-flow island flap transfer from the midpalm for finger reconstruction. Plast Reconstr Surg, 2001, 108(7): 2020-2025.
12.	Omokawa S, Tanaka Y, Shigematsur K, et al. Reverse-flow island flap from the thenar area of the hand. J Reconstr Microsurg, 2002, 18(8): 659-664.
13.	王友华, 汤锦波, 成红兵, 等. 带血管神经蒂的大鱼际近端皮瓣修复指腹缺损. 中华手外科杂志, 2001, 17(4): 206-208.
14.	孙战胜. 薄型皮瓣修复手部外伤后软组织缺损. 中国修复重建外科杂志, 1997, 11(6): 353-355.
15.	Lee TP, Liao CY, Wu IC, et al. Free flap from the superficial palmar branch of the radial artery (SPBRA flap) for finger reconstruction. J Trauma, 2009, 66 (4): 1173-1179.

1. Jihui JU, Liu Y, Hou R. Ulnar artery distal cutaneous descending branch as free flap in hand reconstruction. Injury, 2009, 40(12): 1320-1326.
2. Gao W, Yan H, Li Z, et al. The free dorsoradial forearm perforator flap: anatomical study and clinical application in finger reconstruction. Ann Plast Surg, 2011, 66(1): 53-58.
3. Chen C, Tang P, Zhang X. Sensory reconstruction of a finger pulp defect using a dorsal homodigital island flap. Plast Reconstr Surg, 2012, 130(5): 1077-1086.
4. Takeishi M, Shinoda A, Sugiyama A, et al. Innervated reverse dorsal digital island flap for fingertip reconstruction. J Hand Surg (Am), 2006, 31(7): 1094-1099.
5. 李学渊, 王晓峰, 滕晓峰, 等. 游离腓动脉肌皮穿支皮瓣修复手部皮肤缺损. 中华手外科杂志, 2007, 23(4): 214-215.
6. Sakai S. Free flap from the flexor aspect of the wrist for resurfacing defects of the hand and fingers. Plast Reconstr Surg, 2003, 111(4): 1412-1420.
7. 赵民, 田德虎, 邵新中, 等. 腕部掌侧桡动脉掌浅支横行微型皮瓣的解剖学研究. 中国修复重建外科杂志, 2013, 27(7): 864-868.
8. Yang JW, Kim JS, Lee DC, et al. The radial artery superficial palmar branch flap: a modified free thenar flap with constant innervation. J Reconstr Microsurg, 2010, 26(8): 529-538.
9. Sassu P, Lin CH, Lin YT, et al. Fourteen cases of free thenar flap: a rare indication in digital reconstruction. Ann Plast Surg, 2008, 60(3): 260-266.
10. Kim KS, Kim ES, Hwang JH, et al. Thumb reconstruction using the radial midpalmar (perforator-based) island flap (distal thenar perforator-based island flap). Plast Reconstr Surg, 2010, 125(2): 601-608.
11. Omokawa S, Tanaka Y, Ryu J, et al. Anatomical consideration of reverse-flow island flap transfer from the midpalm for finger reconstruction. Plast Reconstr Surg, 2001, 108(7): 2020-2025.
12. Omokawa S, Tanaka Y, Shigematsur K, et al. Reverse-flow island flap from the thenar area of the hand. J Reconstr Microsurg, 2002, 18(8): 659-664.
13. 王友华, 汤锦波, 成红兵, 等. 带血管神经蒂的大鱼际近端皮瓣修复指腹缺损. 中华手外科杂志, 2001, 17(4): 206-208.
14. 孙战胜. 薄型皮瓣修复手部外伤后软组织缺损. 中国修复重建外科杂志, 1997, 11(6): 353-355.
15. Lee TP, Liao CY, Wu IC, et al. Free flap from the superficial palmar branch of the radial artery (SPBRA flap) for finger reconstruction. J Trauma, 2009, 66 (4): 1173-1179.

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CLINICAL APPLICATION OF MICRO TRANSVERSE FLAP PEDICLED WITH SUPERFICIAL PALMAR BRANCH OF RADIAL ARTERY FROM PALMAR WRIST TO REPAIR SKIN DEFECT OF FINGER

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