The Anatomy And Clinical Application Of The Fasciocutaneous Flap Of Dorsal Branche Of Digital Artery

Background: Defect of finger tip is the commom finger tip injury in hand surgery clinically. It is major the defect of soft tissue in the extent of finger paratelum. The injury causes include cutting,crushing,cracking,mutilation and ect. It is very commom in the clinical work of hand surgery, Almost 1/3 of emergency in hand surgery.Treatment of fmger tip defect is considered according to the factors including trauma condition,age,requirement of profession and ect. For example, the requirements of reparation and reconstitution are different between rough vigorous hands(building,farming) and delicate smart hands(palying piano).There are lots of treatments for finger tip tissue defect, including:①conservative treatment, waiting for per secundam intentionem.②Suturing mutilated tissue in situ.③Free dermatoplasty(full thick skin graft or subdermal vascular plexus free skin graft).④Digiti pedis complex tissue mass graft.⑤Decurtating bones of fingers and suturing directly.⑥skin flap transplantation.⑦Reimplanting vascular inosculated in finger tip.⑧Reimplanting vascular inosculated in digiti pedis and abdomen of toes. In all, There are different principle of reparation treatment in different defect type of finger tip, but the mode are not definitive.Clinically about 1/3 of finger tip injury needs skin flap reparation.The indication for skin flap reparation including:①Remaining the lenghth is very important, such as thumb.②There deep tissue is exposed, such as bone and tendon and etc.③It can remain the finger nail.According to the relationship between skin flap and injury finger, it can be divided into 3 kinds listed below.(1) regional flap: It is obtained from the injury finger,category and improving methods were various, easy to dissect and little injury to donor site.(2) Periposition flap on hands: It was obtained from injury hand except the injury finger, It can be use to repair a large area injury in finger tip. Somtimes,The injury to donor site are great, such as cross finger flap,thenar flap and vascular nervous islet flap in different fingers and so on.(3) Distant skin flap: It is obtained from the place except the injury hand, It needs compulsive position crossing fixure and cutting the pedicel in second stage, such as femoris fissure flap,subclavicular flap,rump flap and so on.Objective: To introduce the clinical application and anatomic foundation of the reverse fascial pedicle island Flap of the digital artery dorsal branches in repairing finger skin defect.Methods: By use of the dorsal branches of midplate Digital artery as the fascial pedicel, the reverse island flap was designed.and was get to repair finger skin defectResults: The reverse fascial pedicle island Flap of the digital artery dorsal branches survived,the patient was satisfied with the consequence, the appearance of the donor site where was dermatoplasty was contented .and the function of interphalangeal joint was satisfactory,the scar was small.Conclusion: These Flaps have the advantages of an extended skin paddle and aversatile pivot point on the phalanx,and they allow Coverage of wide and distal defects.