Anatomical basis of the V-Y advancement flap based on the dorsal carpal perforators

Abstract

Objective To provide anatomical basis for the design of the V-Y advancement flap and investigate the morphological characters of the dorsal carpal perforators. Methods From August, 2017 to October, 2018, 30 sides adult specimens of hand were perfused with red latex. The following contents were observed under surgical magnifier: ①The origin, courses, branches, and distribution of the dorsal carpal perforators. ②The characters of dorsal carpal perforators in agreement with the antebrachial and dorsal metacarpal vascular net. Results The dorsal carpal vascular network was composed of deep vascular network (bone and joint network) and superficial vascular network (fasciocutaneous network). The deep vascular network was located at the deep aspect of the extensor tendons and was commonly formed by dorsal carpal branch of radial artery, dorsal carpal branch of anterior interosseous artery, ascending branch of the dorsal carpal perforator from the deep palmar arch, and dorsal carpal branch of ulnar artery. The superficial vascular network was located on the surface of the extensor tendons and was mainly formed by dorsal carpal branch of radial artery, dorsal carpal branch of ulnar artery, dorsal carpal branch of anterior interosseous artery, radial and ulnar myocutaneous branches of posterior interosseous artery, and the perforators from the deep vascular network. The 3rd and 4th perforators puncturing out from the ulnar and radial margins of the extensor tendon had a constant occurrence rate (100%) with an outer diameter of (0.7±0.3) mm and (0.6±0.2) mm, respectively, and a length of (1.1±0.4) cm and (0.9±0.4) cm, respectively. They were divided into the ascending branch, descending branch, and collateral branch. And finally anastomosis with antebrachial and dorsal metacarpal perforators. Conclusion The V-Y advancement flap based on the dorsal carpal perforators can be a good choice for restoring the dorsal metacarpal defects. Key words: The dorsal carpal perforators; Perforator flap; Advancement flap; Applied anatomy