Reconstruction Of Defect Of Soft Tissue In The Ventral Thumb Relating Anatomy And Clinical Application Of The Study

Backgrounds: Hands are important parts of a body, especially the thumb which accounts for 50% of the functions of the hand. it is especially important.Defect of soft tissue in the ventral thumb and how to choose the appropriate repair method can not only keep its length, without affecting the function, the most important thing is covered by the sensory and painless soft tissue, thus maximizing the "physiological" retains the function of the thumb.Objective: Through the study of digital artery and nerve anatomy, according to the position and the size of the defect, the different flaps are selected to repair the soft tissue defect of thumb, thus it compares the various advantages and disadvantages of the flaps, and provides a theoretical basis for prostheses way of the soft tissue defect of thumb.Methods: Through the study of eight hand specimens, the specimens were dissected to investigate the Starting point,Course,branches,external diameter,and the distribution of the cutaneous branches of the proper palmar digital arteries. As a basis for clinical work, According to the position, size,amount of tissue of the soft tissue defect of thumb, it selects the different flaps to repair the soft tissue defect of thumb, and compares the various advantages and disadvantages of the flaps. However, the use of the common flap cannot completely cover the defect if it involves a large area of soft tissues, because the size of flap is too smaller; we design the digital artery with nerve island flap of the middle ring finger to reconstruct a large area of soft tissue of the ventral thumb。Results: 1.There are two types of neighboring relationships for the cutaneous branches of the proper palmar digital arteries and the proper palmar digital nerves at the proximal phalanx; Laterally Dominating Pattern:most of the cutaneous branches go though the lateral side of nerves; Equal Distribution Pattern:there are the same mean of the the cutaneous branches to go though the lateral and medially side of nerves. Most of cutaneous branches go though the lateral side of nerves at the middle phalanx. The proper arteries on both sides merge into the middle of figure and at the end of phalanx , most of cutaneous branches branches to the skin though the wall of nerves. 2. Through the comprehensive comparison of six kinds of flaps, there are the most advantages of the neurovascular pedicle digital island flap to repair the defects in the ventral thumb that involves a large area of soft tissues. 3. The digital artery island flap with nerve of the middle finger ulnar and the radial side of the ring finger is the satisfactory clinical result for the reconstruction of the defects in the ventral thumb that involves a large area of soft tissues.Conclusion: Most of cutaneous branches at the middle phalanx originate from the lateral side of nerves. when the flap was incised in this place, the lateral would be appropriate to retain some soft tissue to avoid the injure of the cutaneous branches, resulting in the blood supply insufficiency of the flap. When the artery flap was incised at the proximal phalanx, proper palmar digital nerves could be segregated from either the wall or lateral of flap, the wall or lateral would be appropriate to retain some soft tissue , and it would be relatively safer. The defects in the ventral thumb that involves a small area of soft tissues should choose the neurovascular pedicle digital island flap is better.The digital artery island flap with nerve of the middle finger ulnar and the radial side of the ring finger is the ideal flap for the reconstruction of the defects in the ventral thumb that involves a large area of soft tissues.