2 metacarpal flap for defects of the fingers
first two metacarpal flapfinger defects described Y. Maruyama in 1990.G. Dautel and M. Merle in 1991-1992 provided a large number of the use of this flap observations.
Inbox tissue.The skin, subcutaneous fat, II of dorsal metacarpal artery rear subcutaneous veins.
blood supply.Due to the back of II metacarpal artery.Blood flow in the flap is carried by retrograde deep anastomoses in cervical III metacarpal region.
anatomy of vascular pedicle.Block II tissue around the back metacarpal artery: rear aponeurosis II interosseous muscle, subcutaneous fat, subcutaneous veins.Anatomically this artery is variable, it can be a sufficiently large diameter, or absent altogether.When planning the operation is essential to ensure its presence by Doppler studies.
2 metacarpal flap finger defects.Dimensions.3 cm length, 2 cm width intake flap zone
2 metacarpal flap finger defects.Indications.Defects in the back and side surfaces of the III finger metacarpophalangeal joint to the proximal interphalangeal joint.
Layout flap surgical technique.The area of the flap fence is in the proximal part of the rear of the second period mezhpyastnogo (proximal border - dorsal wrist crease).Incision is made along the contours of the markup, in the proximal border of the flap and find the back bandage II metacarpal artery.The flap is lifted.Perform incision distally along mezhpyastnogo II period, emit no skeletization leg artery graft unit, including its fascia mezhpyastnogo II period, one or more saphenous veins, a small amount of subcutaneous fat.Feature II back metacarpal artery is that it passes under the extensor tendons and cross them.Therefore, in the process of lifting the flap with his leg carried out under the extensors.The point of rotation is located on the foot of the cervix III metacarpal bone level at the place of origin of the deep palmar arterial anastomoses in vessels.Take off the wiring, make sure the blood supply to the flap produce hemostasis.After a rotation flap is carried out in the area of the defect through a subcutaneous tunnel or a separate incision and sutured to the defect.
II metacarpal flap retrograde blood flow: * - point rotation
Features release flap.You must carefully allocate leg flap in the neck of III metacarpal region.The flap is carried out under the extensors in the field of crossing them.
Dangers.Damage to the axial artery, compression and torsion legs.