Free Medial Plantar Artery Perforator (MPAP) Flap for the Resurfacing of Finger Defect-Report of Two Cases

內蹠動脈穿通支游離皮瓣重建指端缺損－兩病例報告

賴慶鴻(Ching-Hung Lai) ； 林幸道(Chung-Sheng Lai) ； 賴春生(Sin-Daw Lin) ； 張高評(Kao-Ping Chang)

《中華民國整形外科醫學會雜誌》 18卷2期 (2009/06) Pp. 190-197

https://doi.org/10.7096/JPSA.200906.0190

摘要

背景：
外傷造成的指端缺損已知有很多種重建方式。
目的及目標：
本篇報告以內蹠動脈穿通支所供應之游離皮瓣來重建指端缺損。
材料及方法：
報告中兩病例皆為手指遠端三分之一或併中段三分之一缺損，合併肌腱、韌帶或指骨暴露。內蹠動脈穿通支游離皮瓣皆由病患腳掌內側取得，其穿通支管徑皆為0.8mm以下。
結果：
皮瓣之靜脈回流以伴行靜脈或真皮下靜脈為吻合血管，惟其伴行靜脈管徑一般較小(≦0.4mm)，不易進行吻合，故易出現吻合失敗而造成皮瓣靜脈鬱積。此情形出現時，由於皮瓣較小，以藥物併用針扎紓放靜脈血仍有救癒機會。
結論：
此皮瓣優點為：1.其解剖構造頗為近似手部手指之襯墊結構，2.供皮瓣區之遠端血液循環可不受影響，3.分離皮瓣相對較簡單…等。缺點為其穿通支較細，需良好的儀器與技術配合以提高成功率。與其他手指端重建方式相較，此游離皮瓣為使用於重建指端缺損的一個精緻的選擇。

並列摘要

Background:
Finger destruction secondary to trauma represents a much more significant influence on the activity of daily living. Various surgical techniques contribute to cover the distal defect of the finger.
Aim and Objectives:
We would like to introduce a find-designed perforator skin flap to reconstruct the finger defects.
Material and Method:
Two patients received free medial plantar artery perforator (MPAP) flaps to resurface the palmar defects of fingers. The flaps were harvested without interrupting the circulation of the medial plantar artery. The flap perforator was anastomosed to proper digital artery and the superficial vein of the MPAP flap was anastomosed to dermal vein of the injured finger which had no severe length discrepancy or metacarpophalangeal joint injury.
Results:
One male and one female patient were arranged for free MPAP flap reconstruction in March and August 2007. The mobility of the fingers was not restricted after surgery. One flap survived completely with no vascular compromise. Another flap encountered venous congestion and only partially failed (30% loss) after salvage.
Conclusion:
The MPAP flap is a suitable choice to reconstruct defect of the finger with less donor site morbidity. The cushiony characteristic of the MPAP flap is anatomically similar to the pulp tissue of fingers. Technical difficulty is focused on anastomosis of perforators (diameter≦ 0.8mm) and limited access of concomitant vein. With the many advantages of the MPAP flap, it is worthy of application to more reconstruction needs, particularly for finger defects.

並列關鍵字

finger defect ； medial plantar artery perforator flap ； donor site morbidity