OBJECTIVE: To investigate the effectiveness of dorsal perforator flap of cross-finger proper digital artery in the treatment of finger soft tissue defect caused by high-pressure injection injury. METHODS: Between July 2011 and June 2020, 14 cases of finger soft tissue defect caused by high-pressure injection injury were repaired with dorsal perforator flap of cross-finger proper digital artery. All patients were male, with a mean age of 36 years (range, 22-56 years). The defects were located on the index finger in 8 cases, middle finger in 4 cases, and ring finger in 2 cases. The causes of injury include 8 cases of emulsion paint injection, 4 cases of oil paint injection, and 2 cases of cement injection. The time from injury to debridement was 2-8 hours, with a mean time of 4.5 hours. The soft tissue defects sized from 4.0 cm×1.2 cm to 6.0 cm×2.0 cm. The flaps sized from 4.5 cm×1.5 cm to 6.5 cm×2.5 cm. The donor site of the flap was repaired with skin graft. The pedicle was cut off at 3 weeks after operation, and followed by functional exercise. RESULTS: All flaps and skin grafts at donor sites survived, and the wounds healed by first intention. Twelve patients were followed-up 16-38 months (mean, 22.6 months). The texture and appearance of all flaps were satisfactory. The color and texture of the flaps were similar to those of the surrounding tissues. The two-point discrimination of the flap was 10-12 mm, with a mean of 11.5 mm. There were different degrees of cold intolerance at the end of the affected fingers. At last follow-up, the finger function was evaluated according to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association, 3 cases were excellent, 8 cases were good, and 1 case was poor. CONCLUSION The dorsal perforator flap of cross-finger proper digital artery can effectively repair finger soft tissue defect caused by high-pressure injection injury. The operation was simple, and the appearance and function of the finger recover well.
Humans ; Male ; Adult ; Female ; Perforator Flap ; Upper Extremity ; Fingers/surgery* ; Ulnar Artery ; Skin Transplantation

OBJECTIVE: To explore clinical effects of repairing skin and soft tissue defect of finger with free posterior interosseous artery perforator flap. METHODS: Totally 8 patients with finger skin and soft tissue defect repaired with free posterior interosseous artery perforator flap were treated from May 2021 to November 2022, including 7 males and 1 female aged from 24 to 54 years old, and soft tissue defect area ranged from 3.0 cm×1.5 cm to 5.0 cm×3.0 cm. The time from injury to flap repair ranged from 3 to 83 h. The free posterior interosseous artery perforator flap was applied to repair finger defect, the area of the flap ranged from 3.5 cm×2.0 cm to 5.2 cm×3.5 cm, the donor area of flap was sutured directly. The survival, appearance, texture and donor complications of the flap were observed after operation, and Dargan functional standard was used to evaluate clinical effect of finger function. RESULTS: All flap of 8 patients were survived, and followed up from 3 to 12 months. There was no obvious swelling, soft texture, obvious pigmentation, linear intaglio in donor area only, and without obvious complications were found. Among them, 3 patients'skin flaps were repaired for the defect of palm of the fingers, and sensory recovery was good, two-point discrimination ranged from 5 to 9 mm. According to Dargan functional evaluation, 3 patients excellent, and 5 good. CONCLUSION Free posterior interosseous artery perforation branch flap could be used to repair the defect of finger. The thickness of flap is moderate, operation is convenient, appearance and texture of the operative flap are good, and the donor site is small without obvious complications, and obtain satisfactory clinical effect.
Male ; Humans ; Female ; Young Adult ; Adult ; Middle Aged ; Perforator Flap ; Fingers ; Upper Extremity ; Ulnar Artery ; Skin

OBJECTIVE: To explore clinical effects of the stageⅠrepair of full-thickness skin defect at dorsal skin of middle phalanx fingers using artificial dermis combing with digital artery perforator fascial flaps. METHODS: From January 2019 to May 2020, 21 patients(27 middle phalanx fingers)with full-thickness skin defect were repaired at stageⅠusing artificial dermis combing with digital artery perforator fascial flaps. All patients were emergency cases, and were accompanied by the exposure of bone tendon and the defects of periosteum and tendon membrane. Among patients, including 11 males and 10 females aged from 18 to 66 years old with an average age of (39.00±8.01) years old;9 index fingers, 10 middle fingers and 8 ring fingers;range of skin defect area ranged from (2.5 to 3.5) cm×(1.5 to 3.0) cm;range of exposed bone tendon area was (1.5 to 2.0) cm×(1.0 to 2.0) cm. The time from admission to hospital ranged from 1 to 6 h, operation time started from 3 to 8 h after injury. RESULTS: All patients were followed up from 6 to12 months with an average of (9.66±1.05) months. The wounds in 26 cases were completely healed at 4 to 6 weeks after operation. One finger has changed into wound infection with incompletely epithelialized dermis, and achieved wound healing at 8 weeks after dressing change. All fingers were plump with less scars. The healed wound surface was similar to the color and texture of the surrounding skin. These fingers have excellent wearability and flexibility. According to the upper limb function trial evaluation standard of Hand Surgery Society of Chinese Medical Association, the total score ranged from 72 to 100. 26 fingers got excellent result and 1 good. CONCLUSION StageⅠrepair of full-thickness skin defect at dorsal skin of middle phalanx fingers using artificial dermis combing with digital artery perforator fascial flaps is easy to operate with less trauma. It has made satisfactory recovery of appearance and function of fingers. It could provide an effective surgical method for clinical treatment of full-thickness skin loss of fingers with tendon and bone exposure.
Female ; Male ; Humans ; Adult ; Middle Aged ; Adolescent ; Young Adult ; Aged ; Fingers ; Skin ; Perforator Flap ; Ulnar Artery ; Dermis

OBJECTIVE: To explore a surgical method for the reconstruction of volar soft tissue defect and sensory and vascular repair in middle and far phalangeal digits. METHODS: From January 2016 to January 2020, a total of 14 patients , 9 males and 5 females, ages ranging from 22 to 69 years old, and with volar soft tissue defects in the middle and distal digits 2 to 4, underwent surgical reconstruction using the V-Y shaped flap with digital artery and nerve at the metacarpophalangeal joint. The defect area was (2.0~2.5) cm×(1.5 ~2.0) cm. The procedure involved the harvest of a V-Y shaped flap with the digital artery and nerve from the metacarpophalangeal joint. Flap design, dissection of blood vessels and nerves, and anastomosis with the digital artery and nerve were performed according to a standardized protocol., Functional exercise of affected finger was initiated 3 weeks postoperatively. Subsequent assessments were conducted to evaluate finger pulp sensation, shape and other relevant parameters. According to the upper extremity functional evaluation standard set up by Hand Surgery Branch of Chinese Medical Association, the surgical outcomes were evaluated. RESULTS: All 14 cases demonstrated successful tissue transplantation, , with immediate recovery of sensation observed in 10 cases with distal finger pulp defects. Four patients with middle phalangeal defects experienced gradual sensory recovery within 2 to 3 months postoperatively. Thirteen patients were followed up for a mean duration of (8.8 ± 4.49) months, during which satisfactory outcomes were observed. The average two-point resolution of the finger pulp was 4-6mm, and sensory function evaluation yielded a score of S3 or above. Patients exhibited realistic finger shape, normal skin color and temperature, good wear resistance, and cold resistance. Furthermore, finger joint function was essentially normal. CONCLUSION The V-Y shaped flap with digital artery and nerve at the metacarpophalangeal joint offers a suitable solution for repairing the defect of the middle or distal phalangeal finger. This technique is characterized by its simplicity, low risk, and favorable outcomes, including restored finger shape, blood supply and sensation. Moreover, high patient satisfaction was achieved.
Male ; Female ; Humans ; Young Adult ; Adult ; Middle Aged ; Aged ; Plastic Surgery Procedures ; Skin Transplantation ; Finger Injuries/surgery* ; Treatment Outcome ; Soft Tissue Injuries/surgery* ; Fingers/surgery* ; Ulnar Artery/surgery* ; Metacarpophalangeal Joint/surgery*

Objective: To explore the clinical effects of proximal ulnar artery perforator flap combined with iliac bone graft in the reconstruction of subtotal thumb or finger defects. Methods: A retrospective observational study was conducted. From August 2016 to August 2019, 7 patients with thumb or finger defects caused by mechanical damage who met the inclusion criteria were admitted to Ruihua Affiliated Hospital of Soochow University, including 6 males and 1 female, aged 46 to 58 years. Their length of fingers was repaired with iliac bone, with length of 2.0 to 3.0 cm. After the bone graft, the skin defect area of the affected finger ranged from 2.8 cm×2.2 cm to 6.0 cm×3.2 cm. Then the free proximal ulnar artery perforator flap with area of 3.0 cm×2.4 cm to 6.5 cm×3.5 cm was used to cover the wounds. The wounds in donor sites of iliac crest and flap were directly sutured. The survival of flap in one week post surgery and the donor site wound healing in 2 weeks post surgery were observed, respectively. During the follow-up, the appearance and sensory function of the affected finger, bone healing, and scar hypertrophy of wound in the donor site were observed and evaluated. At the last follow-up, the functional recovery of the affected finger was evaluated with trial standard for the evaluation of functions of the upper limbs of the Hand Surgery Society of Chinese Medical Association. Results: In one week post surgery, all the flaps survived. In 2 weeks post surgery, the iliac bone and the wounds in forearm donor site healed. During the follow-up of 5 to 13 months, the flap was good in appearance, without obvious pigmentation; the sensory recovery reached level S₂ in 5 patients and S₀ in 2 patients; all the grafted iliac bones were bony union without obvious resorption; the wounds in donor site healed well, with only mild scar formation. At the last follow-up, the shape of the reconstructed finger was close to the healthy finger, and the functional evaluation results were excellent in 3 cases and good in 4 cases. Conclusions: The use of proximal ulnar artery perforator flap combined with iliac bone graft to reconstruct subtotal thumb or finger can partially restore part of the appearance and function, with less damage to the donor site. It is a good choice for patients who have low expectations of appearance and function for the reconstructed finger.
Male ; Humans ; Female ; Soft Tissue Injuries/surgery* ; Perforator Flap/transplantation* ; Skin Transplantation/methods* ; Thumb/surgery* ; Plastic Surgery Procedures ; Ulnar Artery/surgery* ; Cicatrix/surgery* ; Ilium/surgery* ; Treatment Outcome

The authors report a rare variation of the vasculature in the upper limbs of an 84-year-old male cadaver. A high bifurcation of the brachial artery occurred bilaterally at the proximal one-third of each arm. The radial arteries were larger than the ulnar arteries and gave origin to the common interosseous arteries. At the cubital fossa, the ulnar arteries traversed medial to the median nerves, continuing superficial to all forearm muscles except the palmaris longus tendon, characteristic of superficial brachioulnar arteries. The aforementioned variations have rarely been reported in previous literature and demonstrate important clinical significance in relation to accidental intra-arterial injections, errors in blood pressure readings, as well as orthopedic, plastic, and vascular surgeries of the upper limbs.
Aged, 80 and over ; Arm ; Arteries ; Blood Pressure ; Brachial Artery ; Cadaver ; Forearm ; Humans ; Injections, Intra-Arterial ; Male ; Median Nerve ; Muscles ; Orthopedics ; Plastics ; Radial Artery ; Reading ; Tendons ; Ulnar Artery ; Upper Extremity

BACKGROUND: A skin defect of the hand and wrist is a common manifestation in industrial crushing injuries, traffic accidents or after excision of tumors. We reconstructed a skin defect in the ulnar aspect of the hand and wrist with a perforator-based propeller flap from the ulnar artery. The aims of our study are to evaluate the utility and effectiveness of this flap and to discuss the advantages and disadvantages of the flap in hand and wrist reconstruction with a review of the literature. METHODS: Between April 2011 and November 2016, five cases of skin defect were reconstructed with a perforator-based propeller flap from the ulnar artery. There were four males and one female. The age of patients ranged from 36 to 73 years. Skin defect sites were on the dorso-ulnar side of the hand in three cases and palmar-ulnar side of the wrist in two cases. The size of the skin defect ranged from 4 × 3 cm to 8 × 5 cm. We evaluated the viability of the flap, postoperative complication and patient's satisfaction. RESULTS: There was no failure of flap in all cases. The size of the flap ranged from 4 × 4 cm to 12 × 4 cm. One patient, who had a burn scar contracture, presented with limited active and passive motion of the wrist after the operation. The other patients had no complications postoperatively. Cosmetic results of the surgery were excellent in one patient, good in three patients, and fair in one patient. CONCLUSIONS: The fasciocutaneous propeller flap based on a perforating branch of the ulnar artery is a reliable treatment option for the ulnar side skin defect of the hand and wrist.
Accidents, Traffic ; Burns ; Cicatrix ; Contracture ; Female ; Hand* ; Humans ; Male ; Perforator Flap ; Postoperative Complications ; Skin ; Ulnar Artery* ; Wrist*

BACKGROUND: Nonliving chickens are commonly used as a microvascular anastomosis training model. However, previous studies have investigated only a few types of vessel, and no study has compared the characteristics of the various vessels. The present study evaluated the anatomic characteristics of various chicken vessels as a training model. METHODS: Eight vessels—the brachial artery, basilic vein, radial artery, ulnar artery, ischiatic artery and vein, cranial tibial artery, and common dorsal metatarsal artery—were evaluated in 26 fresh chickens and 30 chicken feet for external diameter (ED) and thicknesses of the tunica adventitia and media. The dissection time from skin incision to application of vessel clamps was also measured. RESULTS: The EDs of the vessels varied. The ischiatic vein had the largest ED of 2.69±0.33 mm, followed by the basilic vein (1.88±0.36 mm), ischiatic artery (1.68±0.24 mm), common dorsal metatarsal artery (1.23±0.23 mm), cranial tibial artery (1.18±0.19 mm), brachial artery (1.08±0.15 mm), ulnar artery (0.82±0.13 mm), and radial artery (0.56±0.12 mm), and the order of size was consistent across all subjects. Thicknesses of the tunica adventitia and media were also diverse, ranging from 74.09±19.91 µm to 158.66±40.25 µm (adventitia) and from 31.2±7.13 µm to 154.15±46.48 µm (media), respectively. Mean dissection time was <3 minutes for all vessels. CONCLUSIONS: Our results suggest that nonliving chickens can provide various vessels with different anatomic characteristics, which can allow trainees the choice of an appropriate microvascular anastomosis training model depending on their purpose and skillfulness.
Adventitia ; Anastomosis, Surgical ; Arteries ; Brachial Artery ; Chickens* ; Foot ; Metatarsal Bones ; Models, Educational ; Ocimum basilicum ; Radial Artery ; Skin ; Tibial Arteries ; Ulnar Artery ; Veins

BACKGROUND: The authors sought to determine whether a shallow needle approach to the axillary artery would improve complete sensory blocks of median, radial, and ulnar nerves as compared with a perpendicular approach when transarterial axillary block is performed using a scalp vein needle (23G, 3/4'). METHODS: Fifty-four patients were allocated equally to a perpendicular group (the PA group) or a shallow approach group (SA group). Sensory and motor scores were evaluated and compared in the two groups at 5-minute intervals for 20 minutes after block. The main outcome variables were rates of blockage of median, radial, and ulnar nerves. RESULTS: Excellent block rates (defined as completion of surgery using brachial plexus block alone) were obtained in both groups (SA group 77.8% vs. PA group 70.3%, P = 0.755). However, the rate of blockage of all three nerves was significantly higher in the SA group (74% vs. 40.7%, P = 0.013). Furthermore, the rate of complete sensory block of the radial nerve at 20 minutes was significantly greater in the SA group (85.2% vs. 59.3%, P = 0.033). CONCLUSIONS: A shallow needle approach to the axillary artery resulted in a significantly higher median, radial, and ulnar nerve block rate at 20 minutes after LA injection than a perpendicular approach.
Axillary Artery* ; Brachial Plexus Block* ; Brachial Plexus* ; Humans ; Needles* ; Radial Nerve ; Scalp ; Ulnar Nerve ; Veins

BACKGROUND: The authors sought to determine whether a shallow needle approach to the axillary artery would improve complete sensory blocks of median, radial, and ulnar nerves as compared with a perpendicular approach when transarterial axillary block is performed using a scalp vein needle (23G, 3/4'). METHODS: Fifty-four patients were allocated equally to a perpendicular group (the PA group) or a shallow approach group (SA group). Sensory and motor scores were evaluated and compared in the two groups at 5-minute intervals for 20 minutes after block. The main outcome variables were rates of blockage of median, radial, and ulnar nerves. RESULTS: Excellent block rates (defined as completion of surgery using brachial plexus block alone) were obtained in both groups (SA group 77.8% vs. PA group 70.3%, P = 0.755). However, the rate of blockage of all three nerves was significantly higher in the SA group (74% vs. 40.7%, P = 0.013). Furthermore, the rate of complete sensory block of the radial nerve at 20 minutes was significantly greater in the SA group (85.2% vs. 59.3%, P = 0.033). CONCLUSIONS: A shallow needle approach to the axillary artery resulted in a significantly higher median, radial, and ulnar nerve block rate at 20 minutes after LA injection than a perpendicular approach.
Axillary Artery* ; Brachial Plexus Block* ; Brachial Plexus* ; Humans ; Needles* ; Radial Nerve ; Scalp ; Ulnar Nerve ; Veins