Microanatomy And Clinical Application Of The Toetip Artery Arch Branch Flap For The Plastic Surgery Of The Reconstrneted Finger

Free toe transplantation has experienced more than 50 years,the surgical technique is increasingly mature,the survival rate is getting higher and higher,and it is gradually accepted by the majority of patients in the clinic.At present,patients need more than just a good movement and function of reconstructive fingers,but also requires a beautiful appearance,even the realistic shape of reconstructed fingers.Because of the appearance and function of anatomical differences between the second toe with the thumb and finger,there are some "abnormal" in the reconstructed finger compared with normal finger,the most obvious malformations are the bulbous toetip and narrow neck,many scholars are exploring various ways to improve the apperance of the reconstructed fingers.In recent years,we have also done a lot of work in the plastic surgery of reconstructed finger.Our main idea is designing the flap on the bulbous toetip and the flap was transferred to the narrow neck,such an operation can also improve the two abnormal in the reconstruted finger.During the process of cutting the flap,we found the existence of the toetip artery arch and arch branch.And there is no literature has been reported on this artery arch and arch branch.Because of the lack of its anatomy,when the toe artery island flap is used to improve the apperance of the reconstructed finger,the flap is usually cut by the experience of the surgeon,which is easy to damage the branches of the toe artery.When the injury is serious,it can cause postoperative vascular crisis and eventually lead to flap necrosis.The foot tissue is very similar to the hand tissue in texture,shape and other aspects,the foot tissue flap is used to repair the tissue defect of the hand in clinic.The application and use of the second toe tissue to repair the defect of hand in clinical is more popularwith the development and popularization of finger reconstruction technology in recent years.we imagine whether there are toetip artery arch and its branch as the artery anatomy of the finger was known,and the arch branch arteries located just on the bulbous toetip,we can design the flap pedicled with the toetip artery arch branch artery,and transfer the flap to the narrow necl to improve the appearance of the reconstructed finger.The research content is divided into the following four parts:Study the anatomy of the toetip artery arch and arch branch in the part 1.Eight fresh foot specimens were employed with red emulsion infusion from the dorsalis pedis and micro-dissection.Observe the occurrence rate,location and external diameter of the toetip artery arch,and the initiation site,the course,the number and the external diameter of branch artery origined from the toetip artery arch.Results show that the toetip artery arches were identified in all specimens.Dissection showed that all the toetip artery arches had five main terminal branches.In order to facilitate descriptions,we named the five main terminal branches as the first,second,third,fourth,and fifth arch branch from the tibial side to the fibular side of the second toe.The course of the first branch and fifth branch origined from the toe artery arch is mainly towards to the diatal and dorsal,and the branch provide the blood supply of the dorsal skin and nail bed.The course of the second branch and fourth branch origined from the tibial 1/3 segment and the fibula 1/3 segment of the toe artery arch is mainly towards to the diatal toetip,and the branch provide the blood supply of the pulp and toetip.The course of the third branch origined from the middle 1/3 segment of the toe artery arch is mainly towards to the diatal toetip,and the branch also provide the blood supply of the pulp and toetip.Study the anatomy of the toetip artery arch branch artery flap in the part 2.8 fresh foot specimens were selected with red latex from the dorsalis pedis,and the second toes were disconnected from the metatarsophalangeal joints.The second toe side line is side middle line,the distal line is toe nail fold and the proximal line is the distal interphalangeal joint.Observe the vascular pedicle length,the course,blood supply area,anastomosis vessel and know the point,axis line,plane and circular of the toetip artery arch branch flap.Results show that the course of the pedicle vessel is divided into three kinds,the first kind is towards to the side of the toe,the second is towards to the toetip of the toe,the third is towards to the toe pulp.The three types of branch vessels are anastomosed to form a chain vascular network.The formation of the vascular network is an important guarantee for the blood supply of the flap.Study the feasibility of the toetip artery arch branch flap for the plastic surgery of the reconstructed fingers in the part 3.Fresh foot specimens were selected with red latex from the dorsalis pedis,and the second toes were disconnected from the metatarsophalangeal joints.The design of the flap is determined by the position of the bulbous toetip.Results show that the cutting and transplantation of the toetip artery arch branch flap of the toe were successfully completed,the appearance of the second toe was close to the normal finger after the plastic surgery of the reconstructed fingers in fresh specimen.Investigate the treatment of outcomes of reconstructed fingers by the toetip artery arch branch artery flap in the part 4.From January 2014 to January 2017,15 fingers of 13 patients with finger defects accompanied by toe transfer,using the toetip artery arch branch artery flap inserted in the nek of the second toe to correct the appearance defect caused by a narrow neck and a bulbous tip.Results show that all the toetip artery arch branch artery flaps and the reconstructed fingers were survived.All the toetip artery arch branch artery flaps and reconstructed fingers got satisfactory appearance and good sense function.The character of reconstructed finger tip was good,no obvious scar hyperplasia.The range of flexion and extension of reconstructed fingers is well.The sensation of the fingers recovered well and the sensation recovered from S2 to S3+.The patient was satisfied with the appearance of the finger after plastic surgery.Through the above research,we know the anatomical characteristics of the toetip artery arch and arch branch,and design the toetip artery arch branch artery flap,confirm the feasibility of the toetip artery arch branch flap for the plastic surgery of the reconstructed fingers.Finally,the skin flap was applied to the clinic,and a good clinical effect was obtained.