The Extended Distally based Second Dorsal Metacarpal Flap in Hand Reconstruction

延長性第二掌骨間皮瓣在手部重建手術之應用

李訓宗(Hsiun-Tzung Lee) ； 陳天牧(Tim-Mo Chen) ； 宋仁宇(Ren-Yeu Soong) ； 湯有銘(Yu-Ming Tung) ； 鄭天宇(Tan-Yeu Cheng) ； 梁偉中(Wei-Chung Liang) ； 王存福(Triumph Wang) ； 王先震(Hsian-Jenn Wang)

《中華民國重建整形外科醫學會雜誌》 4卷4期 (1995/12) Pp. 231-239

https://doi.org/10.7096/JPRSA.199512.0231

摘要

手部軟組織缺損之重建手術在治療上雖然有許多不同的手術方法，但是在遠端指節、指間空隙、手背及手掌之缺損，外科醫師通常需要更多之考慮“而手術中在皮瓣之選擇上，局部皮瓣或帶血管莖之島狀皮瓣與游離皮瓣之比較除單純及方便手術外，同時在皮膚之構造，厚度及顏色上差異也較相近。於是我們使用延長性第二掌骨間血管皮瓣來重建手部軟組織之缺損，並提出三例報告。此皮瓣是利用第二掌間血管遠端進入皮膚皮瓣之皮返枝血管做為皮瓣之主要營養血管，然後依手術中實際之需要血管莖長度，做不同程度之調整。此皮瓣之血管莖最長可達6~8公分，而皮瓣之大小最大可達65毫米乘35毫米。因此，從血管莖之根部至皮瓣之最遠端之總長度，幾乎可涵蓋整個手掌、手背、大部份手指指節及前臂遠端。而血管莖之長度也有四種不同之選擇，第一是在第二掌骨間動脈遠端皮返枝進入皮瓣處，第二是在第二掌骨間動脈起點處，第三是在橈動脈枝手腕背側動脈弓起點處，第四是在橈動脈之手腕背側枝進入第一背側掌間肌肉處。至於供皮瓣區，如果皮瓣寬度小於35釐米的話，傷口通常可以直接縫合。

並列摘要

An extended distally based second dorsal metacarpal flap is designed. The pedicle of this flap includes the recurrent cutaneous branch from the second dorsal metacarpal artery (SDMA), the SDMA, the partial carpal arterial arch of the dorsal hand, and the dorsal carpal branch of the radial artery. There are four axes of rotation of this flap, the first at the entry of the recurrent cutaneous branch of the SDMA into the skin flap, the second at the SDMA arising from the carpal arterial arch, the third at the origin of the dorsal carpal arch of the radial artery, and the last at the entry of the dorsal carpal branch of the radial artery into the first dorsal interosseous muscle. The length of the pedicle can increase as much as possible via this design. Therefore, the flap can cover a small defect over the palm, dorsum of the hand, all web-spaces and most parts of the fingers. The donor site can be closed primarily if the flap is less than 3.5 cm in width. The flap was used in three consecutive cases with no necrosis of the flap. The donor site was closed directly in two cases and skin grafted in one, with satisfactory results. The anatomy of the flap, operative techniques and three consecutive cases are herein described.

並列關鍵字

second dorsal metacarpal artery ； second dorsal metacarpal flap