The V-Y advancement flap based on the dorsal carpal perforators for dorsal metacarpal reconstruction: Anatomical and clinical study.

Abstract

Soft-tissue defects on the dorsal hand accompanied by exposed bone and tendon remain a challenge for plastic surgeons. The purpose of this study was to observe the morphological characteristics of the dorsal carpal perforators in the wrist and to design a V-Y advancement flap based on the dorsal carpal perforators. Thirty cadaveric hand specimens were dissected to observe the origin, course, branches, and anastomoses of the dorsal carpal perforators, and a V-Y advancement flap was designed based on these perforators. Clinically, nine cases of dorsal hand defects were reconstructed with this flap. The dorsal carpal vascular network was formed by vascular anastomoses along the dorsal carpal branch of the radial artery, dorsal carpal branch of the anterior interosseous artery, ascending branch of the dorsal carpal perforator from the deep palmar arch, direct branch of the radial artery, dorsal carpal branch of the ulnar artery, posterior interosseous artery, and deep palmar branch of the ulnar artery; this network could be divided into a deep vascular network and superficial vascular network according to the anatomical plane. Among the perforators, the third and fourth perforators that pierce out bilaterally from the tendon of the extensor digitorium had a consistent occurrence rate (100%) with an outer diameter of 0.7 ± 0.3 mm and 0.6 ± 0.2 mm, respectively, and thus could be chosen as the vascular pedicle. In clinical applications, all flaps survived completely with excellent color and texture, a satisfactory appearance, and normal movement of the wrist joint. A V-Y advancement flap based on the dorsal carpal perforators can become a useful choice for the repair of dorsal metacarpal defects caused by trauma or dorsal metacarpal arterial flaps.