The Comparative Study Of The Reconstruction In Finger Defect With The Proper Digital Artery Segment Defect

Objectives To investigate the anatomical characters of the dorsal interosseous artery,the superficial branch of the radial artery,the proper digital artery and the superficial vein of the forearm palmar via fresh upper limb specimens(natural latex perfusion).Based on the anatomical characters,the four flaps were applied to repair the wounds with the proper digital arterial segment defect of the finger by flow-through type.Methods To measure the diameters of the origin and ending points,the length of the vascular pedicle of the dorsal interosseous artery and the superficial palmar branch of the radial artery,respectively.To collect the diameter of the proper digital arteries and the palmar subcutaneous vein of the forearm.The number of the palmar subcutaneous veins was documented.The flaps are executed to repair the patients with finger skin and soft tissue defect with the proper digital artery segment defect,then followed up the appearance of the flaps,and measured the two-point discrimination of the flaps and total active movement of the fingers.Postoperative complications,operation time,patients' satisfaction with finger appearance and flap survival rate of the two groups were included in the comparison.Independent sample t test was used for measurement data,and ?2 was used for counting data P<0.05 was considered statistically significant.Results 1 The diameters of the proper digital artery from the radial side to the ulnar side of the index finger to the little finger were(1.01±0.16)mm,(1.29±0.15)mm,(1.28±0.13)mm,(1.33±0.12)mm,(1.11±0.13)mm,(1.09±0.12)mm,and(0.98±0.11)mm,respectively.The diameters of the origin and ending points of the dorsal interosseous artery and the superficial palmar branch of the radial artery were(1.45±0.10)mm,(0.80±0.09)mm and(1.28±0.32)mm,(1.10±0.32)mm,respectively,and the length of the pedicle was(13.2±1.5)cm and(2.66±0.56)cm.The average diameter of the forearm palmar veins was(1.68±0.29)mm,with an average of(5.3±0.82)veins.2 Both the flap and the injured finger survived without infection.The follow-up of the adjacent proper digital artery flow-through flap repairing was 6 months.The appearance was satisfactory.The two-point discrimination was 6 mm,and the joint had excellent mobility.At 2 months followed-up,the dorsal interosseous artery perforator flap,the appearance of the flap was bloated,the index finger TAM = 95 °,the joint mobility recovery was poor,the patient was unsatisfactory,and the two-point discrimination of the fingertip was 9 mm.All the 40 flaps in group A and group B were followed up.According to the statistical analysis,the difference in the operation time and the two-point discrimination of the flaps in the last follow-up between group A and group B was statistically significant(P<0.05).There was no significant difference in satisfaction,skin flap appearance and range of motion between the two groups(P>0.05).Conclusions 1 The caliber matching degree of the proper digital artery is higher than the others.However,the main blood vessel of the donor finger is sacrificed,so the economy is lower than the others;2 The diameter of the interosseous dorsal artery similar to the proper digital artery,and the trunk is longer.However,the perforators pedicle is too long to kink to affect the blood supply of the flap.And flap is bloated that a second surgery is possibility,so the economy is lower;3 The venous flap and the superficial branch of the radial artery flap can be used to bridge the small area of hand wounds with artery defects,and the economic efficiency is higher than that of the others;4 The superficial palmar branch of the radial artery flap can be used to the reconstruction of the segment defect of the digital artery with a length of 2.6 cm,and the interosseous dorsal artery perforator flap and the venous flap can be applied to the reconstruction of the defect with a length of more than 5 cm;5 Among the four types of flap,venous flap and the superficial branch of the radial artery flap are recommended as the preferred treatment for the finger wound repair with digital artery segment defect,and superficial branch of the radial artery flap is preferred for sensory recovery.The operation of venous flap was relatively easy according to the degree of difficulty.Adjacent finger artery flap and interosseous dorsal artery flap are not recommended as the preferred method because of their inherent defects.Figure 35;Table 7;Reference 151...