Ananatomical Study Of The Dorsal Multi-grade Flap

Background Hand is the most valuable labor tool,it may be hurt by various harmful factors anytime and anywhere in daily work and social activities,which will bring physical and mental pain to the injured.If the hand trauma is not handled properly,it will seriously affect the function and appearance of the fingers.Therefore,the choice of repair method should not only consider the full coverage of the wound,but also pay attention to the recovery of hand function and the improvement of postoperative appearance.Because V-Y propulsion flap has many advantages,for example it’s an simple operation,has small trauma,good flap survival and the texture,skin’s color and skin’s character of the flap is similar to the receiving area and it also has good feeling recovery,strong anti-infection ability and high success rate,it has become the preferred method to repair small and medium-sized finger’s wounds.In current clinical application,V-Y advancement flap is mainly used to repair the volar wound of the finger,and its application in the repair of the finger is limited due to the small propulsion distance of the dorsal finger advancement flap.In view of this,we designed the dorsal propulsion flap to increase the propulsion distance of the dorsal flap by combining the ductility of the skin,the slip between the subcutaneous superficial fascia and the skin,the angular displacement of the dorsal branch from the proper digital artery and the elasticity of the proper digital artery.Objective Increase the propulsion distance of the dorsal flap through the multi-grade effect of the ductility of the skin,the slip between the subcutaneous superficial fascia and the skin,the angular displacement of the dorsal branch from the proper digital artery and the elasticity of the proper digital artery to repair the dorsal wound.Materials and Methods 11 fresh adult cadaveric hands and 34 fingers,we designed the flap separately in the middle segment and proximal segment on the dorsal side of the finger.The contents of the flap include the dorsal skin,the subcutaneous superficial fascia,the proper digital artery on one side of the finger and the dorsal branch from the proper digital artery.We pushed the flap toward the distal back of the finger;the ductility of the skin,the slip between the subcutaneous superficial fascia and the skin,the angular displacement of the dorsal branch from the proper digital artery and the elasticity of the proper digital artery,all four factors play a role during the advancement of the dorsal finger flap respectively,which increases the propulsion distance by the multi-grade superposition of these four functions.Result Through the multi-grade superposition of these four functions of the ductility of the skin,the slip between the subcutaneous superficial fascia and the skin,the angular displacement of the dorsal branch from the proper digital artery and the elasticity of the proper digital artery to increases the propulsion distance,the maximum advancement of the simulated dorsal flap is on the fresh cadaver:the dorsal flap in the middle segment of finger is 2.4 cm and the dorsal flap in the proximal segment of finger is 4.5 cm,The propulsion distance of the proximal dorsal flap is greater than that of the distal dorsal flap.Conclusion The advancement of the dorsal multi-grade advanced flap has increased obviously.The maximum advancement is 4.5cm and the average advancement is 2.5cm.The operation is safe and simple and the dorsal multi-grade advanced flap is one of the ideal flap for the repair of small and medium-sized wounds of the dorsal finger.