APPLICATION OF WRIST CREASE ISLAND FLAP BASED ON THE SUPERFICIAL PALMAR BRANCH OF THE RADIAL ARTERY FOR THUMB RECONSTRUCTION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHENGDawei ¹ , LIZhangcan ¹ , XUli ¹ , ZHANGXuyang ¹ , SHIRongjian ¹ , SUNFeng ¹ , SHOUKuishui ²

1. Department of Hand and Foot Surgery, Xuzhou Renci Hospital, Xuzhou Jiangsu, 221004, P. R. China;
2. Department of Hand Surgery, Wuxi Hand Surgery Hospital;

Corresponding author：

ZHENGDawei, Email: davyzheng93006@163.com

Keywords：

Flow-through flap; Superficial palmar branch of the radial artery; Artery defect; Thumb defect

DOI：

10.7507/1002-1892.20150099

Video：

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Objective To investigate the effectiveness of the island flaps based on the superficial palmar branch of the radial artery (SPBRA) to repair the thumb wound. Methods Between February 2012 and November 2013, 8 cases of thumb defects and bilateral artery defect were treated. There were 5 males and 3 females with an average age of 30.5 years (range, 19-51 years). The injury was caused by crush (4 cases), avulsion (3 cases), and twist (1 case). The injury located at the metacarpophalangeal joints in 3 cases, at the proximal palmar side in 2 cases, and at the interphalangeal joints in 3 cases. The defect size ranged from 3.5 cm×1.5 cm to 6.5 cm×2.0 cm. The digital artery defect was 2.5-8.5 cm (mean, 5.3 cm). The disease duration was 2.0-4.5 hours (mean, 3.2 hours). The reversed island flaps based on the SPBRA were designed, which size was 4.0 cm×2.0 cm to 7.5 cm×3.0 cm. The donor sites were closed directly. Results The operation was successfully completed in 7 patients except 1 patient having vascular variation. All flaps survived completely. Wound and incision at the donor site healed by first intention. All patients were followed up 6-18 months (mean, 13 months). The flaps had similar color and texture to adjacent skin. Linear scar was seen at the donor site in 1 patient, with no functional limitation. According to the functional assessment criteria of upper limb by the Hand Surgery Branch of Chinese Medical Association, the results were excellent in 6 cases, good in 1 case, and fair in 1 case, with an excellent and good rate of 87.5%. Conclusion The reversed island flap based on the SPBRA is an ideal flap for the thumb reconstruction because the advantages of reliable blood supply, easy dissection, less injury at donor site, and good repair results.

Citation： ZHENGDawei, LIZhangcan, XUli, ZHANGXuyang, SHIRongjian, SUNFeng, SHOUKuishui. APPLICATION OF WRIST CREASE ISLAND FLAP BASED ON THE SUPERFICIAL PALMAR BRANCH OF THE RADIAL ARTERY FOR THUMB RECONSTRUCTION. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(4): 457-461. doi: 10.7507/1002-1892.20150099 Copy

1.	李涛, 陈振兵, 丛晓斌, 等. 邻指指动脉Flow-through皮瓣桥接断指血运的临床应用. 中华显微外科杂志, 2014, 37(1):10-13.
2.	周健辉, 李秀文, 石惠文, 等. 组合静脉皮瓣在皮肤缺损断指再植中的应用. 中华手外科杂志, 2014, 30(3):238-239.
3.	程国良, 方光荣. 拇指节段缺损踇趾腓侧半月形皮瓣桥接再植术. 中华显微外科杂志, 1999, 22(2):98-100.
4.	郑大伟, 黎章灿, 许立, 等. Flow-through静脉皮瓣在伴环形缺损断指再植中的应用. 中国修复重建外科杂志, 2014, 28(8):977-980.
5.	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.
6.	郑大伟, 黎章灿, 许立, 等. 桡动脉掌浅支腕横纹皮瓣在手部创面修复中的应用. 中国美容医学杂志, 2014, 23(4):263-266.
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游离移植修复手指皮肤缺损. 中国修复重建外科杂志, 2013, 27(12):1475-1479.
8.	潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3):130-135.
9.	Kamei K, Ide Y, Kimura T. A new free thenar flap. Plast Reconstr Surg, 1993, 92(7):1380-1384.
10.	Kim KS, Hwang JH. Radial midpalmar island flap. Plast Reconstr Surg, 2005, 116(5):1332-1339.
11.	Gellman H, Botte MJ, Shankwiler J, et al. Arterial patterns of the deep and superficial palmar arches. Clin Orthop Relat Res, 2001, (383):41-46.
12.	Omokawa S, Ryu J, Tang JB, et al. Vascular and neural anatomy of the thenar area of the hand:its surgical applications. Plast Reconstr Surg, 1997, 99(1):116-121.
13.	Orbay JL, Rosen JG, Khouri RK, et al. The glabrous palmar flap:the new free or reversed pedicled palmar fasciocutaneous flap for volar hand reconstruction. Tech Hand Up Extrem Surg, 2009, 13(3):145-150.
14.	Olave E, Prates JC, Gabrielli C, et al. Abnormal course of the superficial palmar branch of the radial artery. Surg Radiol Anat, 1996, 18(2):151-153.
15.	Omokawa S, Tanaka Y, Rhu J, et al. Anatomical consideration of reverse-flow island flap transfers from the midpalm for finger reconstruction. Plast Reconstr Surg, 2001, 108(7):2020-2025.
16.	Haddock MC, Creagh T, Sivarajanlp V. Double-free, flow-through flap reconstruction for complex scalp defects:a case report. Microsurgery, 2011, 31(4):327-330.
17.	Sommerlad BC, McGrouther DA. Resurfacing the sole:long-term follow-up and comparison of techniques. Br J Plast Surg, 1978, 31(2):107-116.
18.	Jelicic N, Gajisin S, Zbrodowski A. Arcus palmaris superficialis. Acta Anatomica, 1988, 32(3):187-190.
19.	Bilge O, Pinar Y, Ozer MA, et al. A morphometric study on the superficial palmar arch of the hand. Surg Radiol Anat, 2006, 28(4):343-350.
20.	Coleman SS, Anson BJ. Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obstet, 1961, 113:409-424.
21.	Ruengsakulrach P, Eizenberg N, Fahrer C, et al. Surgical implications of variations in hand collateral circulation:anatomy revisited. J Thorac Cardiovasc Surg, 2001, 122(4):682-686.
22.	郑大伟, 黎章灿, 许立, 等. 桡动脉掌浅支及掌浅弓变异1例. 解剖科学进展, 2014, 20(5):498.
23.	Tagil SM, Bozkurt MC, Kuvat SV, et al. A variant course of the superficial palmar branch of the radial artery. Surg Radiol Anat, 2012, 34(9):871-873.

1. 李涛, 陈振兵, 丛晓斌, 等. 邻指指动脉Flow-through皮瓣桥接断指血运的临床应用. 中华显微外科杂志, 2014, 37(1):10-13.
2. 周健辉, 李秀文, 石惠文, 等. 组合静脉皮瓣在皮肤缺损断指再植中的应用. 中华手外科杂志, 2014, 30(3):238-239.
3. 程国良, 方光荣. 拇指节段缺损踇趾腓侧半月形皮瓣桥接再植术. 中华显微外科杂志, 1999, 22(2):98-100.
4. 郑大伟, 黎章灿, 许立, 等. Flow-through静脉皮瓣在伴环形缺损断指再植中的应用. 中国修复重建外科杂志, 2014, 28(8):977-980.
5. 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.
6. 郑大伟, 黎章灿, 许立, 等. 桡动脉掌浅支腕横纹皮瓣在手部创面修复中的应用. 中国美容医学杂志, 2014, 23(4):263-266.
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游离移植修复手指皮肤缺损. 中国修复重建外科杂志, 2013, 27(12):1475-1479.
8. 潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3):130-135.
9. Kamei K, Ide Y, Kimura T. A new free thenar flap. Plast Reconstr Surg, 1993, 92(7):1380-1384.
10. Kim KS, Hwang JH. Radial midpalmar island flap. Plast Reconstr Surg, 2005, 116(5):1332-1339.
11. Gellman H, Botte MJ, Shankwiler J, et al. Arterial patterns of the deep and superficial palmar arches. Clin Orthop Relat Res, 2001, (383):41-46.
12. Omokawa S, Ryu J, Tang JB, et al. Vascular and neural anatomy of the thenar area of the hand:its surgical applications. Plast Reconstr Surg, 1997, 99(1):116-121.
13. Orbay JL, Rosen JG, Khouri RK, et al. The glabrous palmar flap:the new free or reversed pedicled palmar fasciocutaneous flap for volar hand reconstruction. Tech Hand Up Extrem Surg, 2009, 13(3):145-150.
14. Olave E, Prates JC, Gabrielli C, et al. Abnormal course of the superficial palmar branch of the radial artery. Surg Radiol Anat, 1996, 18(2):151-153.
15. Omokawa S, Tanaka Y, Rhu J, et al. Anatomical consideration of reverse-flow island flap transfers from the midpalm for finger reconstruction. Plast Reconstr Surg, 2001, 108(7):2020-2025.
16. Haddock MC, Creagh T, Sivarajanlp V. Double-free, flow-through flap reconstruction for complex scalp defects:a case report. Microsurgery, 2011, 31(4):327-330.
17. Sommerlad BC, McGrouther DA. Resurfacing the sole:long-term follow-up and comparison of techniques. Br J Plast Surg, 1978, 31(2):107-116.
18. Jelicic N, Gajisin S, Zbrodowski A. Arcus palmaris superficialis. Acta Anatomica, 1988, 32(3):187-190.
19. Bilge O, Pinar Y, Ozer MA, et al. A morphometric study on the superficial palmar arch of the hand. Surg Radiol Anat, 2006, 28(4):343-350.
20. Coleman SS, Anson BJ. Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obstet, 1961, 113:409-424.
21. Ruengsakulrach P, Eizenberg N, Fahrer C, et al. Surgical implications of variations in hand collateral circulation:anatomy revisited. J Thorac Cardiovasc Surg, 2001, 122(4):682-686.
22. 郑大伟, 黎章灿, 许立, 等. 桡动脉掌浅支及掌浅弓变异1例. 解剖科学进展, 2014, 20(5):498.
23. Tagil SM, Bozkurt MC, Kuvat SV, et al. A variant course of the superficial palmar branch of the radial artery. Surg Radiol Anat, 2012, 34(9):871-873.

Chinese Journal of Reparative and Reconstructive Surgery

APPLICATION OF WRIST CREASE ISLAND FLAP BASED ON THE SUPERFICIAL PALMAR BRANCH OF THE RADIAL ARTERY FOR THUMB RECONSTRUCTION

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