Anatomy and clinical application of a free perforator flap of the middle segment perforator of ulnar artery
10.3760/cma.j.cn441206-20231123-00085
- VernacularTitle:尺动脉中段穿支游离皮瓣的解剖及其临床应用
- Author:
Zhuoxuan CHENG
1
;
Songxia HE
;
Rui WU
;
Wang ZHANG
;
Tao WANG
;
Kai YU
;
Peng WEI
;
Yuxin LIU
Author Information
1. 宁波一院龙山医院医疗健康集团手外科，慈溪 315312
- Publication Type:Journal Article
- Keywords:
Perforator in the middle segment of ulnar artery;
Perforator flap;
Digital;
Soft tissue defect;
Applied anatomy
- From:
Chinese Journal of Microsurgery
2024;47(6):655-661
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the anatomy of the perforator flap of a perforating branch in the middle segment of ulnar artery and explore the surgical procedure and clinical effects on reconstruction of soft tissue defects in digits.Methods:From January 2021 to December 2022, an preliminary anatomical study on 8 upper limbs of 4 chilled fresh specimen of adults were carried out at the Department of Hand Surgery, Ningbo First Hospital Longshan Hospital Medical and Health Group. The anatomical study investigated the perforating branches in the middle segment of ulnar artery, and the location, quantity, outer diameter, course and distribution of the perforating branches were all recorded. SPSS 26.0 software was used for statistical process of the data, and t-test was performed according to the left and right sides. P<0.05 was considered statistically significant. Over the same period, 10 patients with soft tissue in digits defects were reconstructed with transfer of free perforator flap of the middle segment perforator of ulnar artery. All the digital injuries accompanied with various degrees of tendon or phalangeal exposure. The sizes of soft tissue defects were 1.5 cm×1.8 cm to 2.8 cm×3.5 cm. The flaps of the middle segment perforator of ulnar artery sized 1.8 cm×2.0 cm-3.0 cm×3.8 cm. Donor sites were directly sutured. Outpatient follow-up and home visit were conducted after surgery. Patients who were from other regions and not convenient to pay a visit to the hospital were reviewed through WeChat or smartphone to observe the appearance, texture, sensory recovery, and digit function. Results:There was a constant perforating branch in the middle segment of ulnar artery, at 9.89 cm±0.40 cm from the proximal end of pisiform bone, with an outer diameter of 0.71 mm±0.13 mm at the root and there was a length of 2.10 cm±0.32 cm available for vascular pedicle. There was no significant difference between the data of left and right. After surgery, 8 flaps survived smoothly with stage-I healing, and 2 flaps appeared venous occlusion on the second day after surgery and after a symptomatic treatment, the flaps survived with minor pigmentation. All 10 donor sites had stage-I healing. Follow-ups were conducted for 3-20 months, with an average of 10.5 months. The appearance, elasticity, texture, and colour of the flaps were all satisfactory. Four flaps were sutured with nerves, and the sensation recovery of these flaps achieved to S 3+ with TPD at 9-14 mm, at 11.25 mm in average. The 6 flaps without nerves suture had the sensation recovery to S 3. According to the Dargan functional evaluation criteria, the function of 6 digits were in excellent, 3 in good and 1 in poor. The Vancouver Scar Scale (VSS) was employed to evaluate the postoperative scars, and the scores were 3-6 points and at 4.08 points in average. Conclusion:Free perforator flap of the perforating branch in middle section of ulnar artery has a constant vascular pedicle, and it offers a satisfactory skin texture and appearance. It is simple to operate, does not have to sacrifice the main blood vessel, and there is a concealed donor site. It is an ideal flap for reconstruction of digital defects.
