Applied anatomy and clinical application of the perforator flap at the neck of radial first metacarpus
10.3760/cma.j.cn441206-20250306-00051
- VernacularTitle:第1掌骨颈桡侧穿支皮瓣的应用解剖及其临床应用
- Author:
Shaokun PEI
1
;
Huixiao LI
1
;
Zhonghui PANG
1
;
Lifeng XIA
1
;
Wenlong XU
1
Author Information
1. 西北大学第一医院手外科，西安 710043
- Publication Type:Journal Article
- Keywords:
Perforator flap of the neck of first radial metacarpus;
First metacarpal radial artery;
Applied anatomy;
Digit;
Soft tissue defect;
Repair
- From:
Chinese Journal of Microsurgery
2025;48(3):326-332
- CountryChina
- Language:Chinese
-
Abstract:
Objective:Through anatomical observations, anatomical data on the radial perforating vessels around the neck of first metacarpus were observed and classified, hence to provide an anatomical evidence for clinical application of the flap based on the perforating vessels.Methods:From July 2022 to June 2023, 15 fresh adult upper limb specimens were studied at the Department of Hand Surgery, Northwest University First Hospital. All perforators within the zone for flap design around the neck of radial first metacarpus were observed. The number, origin and outer calibre of the perforators were recorded. Perforators with an outer diameter greater than 0.13 mm were defined as dominant arteries. SPSS 20.0 statistical software was used to count the number and outer diameter of cutaneous branches originating from the radial artery of the first metacarpal bone, the radial palmar proper artery of thumb and other arteries. The results were expressed as mean ± standard deviation ( ± s), with P<0.05 indicating statistical significance. From July 2023 to May 2024, 14 patients (10 males, 4 females and aged 27-53 years) with digital soft tissue defects were treated. The defects were of 3 thumbs, 4 index fingers, 5 middle fingers, 1 ring finger and 1 little finger, and sized from 2.5 cm × 2.0 cm to 4.0 cm × 2.5 cm. The perforator flaps of the neck of radial first metacarpus (3.0 cm × 2.5 cm - 4.5 cm × 3.0 cm) were harvested and donor sites were closed directly in the emergency surgery. Follow-up through the visits of outpatient clinic and via telephone and WeChat interviews to assess the flap survival, digital function and aesthetics of the flap. Results:In the specimens, it was found that about 75% of dominant perforators were originated from the first metacarpal radial artery. There were statistical significance in the number and outer calibre of the perforators between the first metacarpal radial artery, radial proper palmar digital artery of thumb and other arteries ( P<0.05). Postoperative follow-up lasted for 5-12 (mean 10.1) months, all flaps survived after surgery. Sensation regained according to the British Medical Research Council (BMRC), and they were: S 2 in 6 flaps and S 3 in 8 flaps. According to Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 11 digits were excellent and 3 in good. Scar evaluation scored 3-4 (mean 3.43) points according to the Vancouver Scar Scale (VSS). Conclusion:The perforator flap around the neck of first radial metacarpus is primarily supplied by the radial artery of the first metacarpus. This flap achieves satisfactory functional and aesthetic outcomes with good sensory recovery, therefore it is an ideal flap for reconstruction of digital soft tissue defect.
