Anatomic Basis of Dorsal Finger Skin Cover

Abstract

This study describes the anatomy of the dorsal cutaneous vascular system of 180 digits (36 thumbs, index, middle, ring, and little fingers) from 18 pairs of fresh human cadaver hands. The aim of this paper is to incorporate the anatomic data into the current way of designing the homodigital adipofascial turnover flap for cutaneous coverage of the dorsum of the finger. We have carried out an anatomic study in preserved cadaver hands to define the distance between the joint and the origin of the dorsal cutaneous branches of the proper palmar digital artery in the proximal and middle phalanx of the long fingers and for the thumb to metacarpal and interphalangeal joint. All branches of the proper digital artery that ran to the dorsal skin were then identified, and their diameters and the distances of their origins from the proximal interphalangeal joint were measured. We showed that 2 constant branches in the proximal and middle phalanx from each proper digital artery have consistent sites of origin at predictable distances from the proximal interphalangeal joint for the long fingers and the metacarpal and interphalangeal joint for the thumb. The flap survival was excellent, and no donor site complications were observed. We showed that these branches have consistent sites of origin at predictable distances from the proximal interphalangeal joint. The adipofascial turnover arterial flap has appeared as an excellent alternative to achieve early coverage of cutaneous wounds at the dorsal aspect of the fingers.

Repair of Dorsal Defects Over the Middle Phalanx and Proximal Interphalangeal Joint With a Transposition Flap From the Dorsum of the Proximal Phalanx

“…1,11,16 Therefore, the transposition flap described in the present study can be harvested from the MCP joint line to the PIP joint line between the midaxial lines. The flap size is usually sufficient to cover the defect on the dorsum of the middle phalanx and the PIP joint.…”

Predictable Pattern Digital Artery Perforator Flap

“…These branches are identified intraoperatively based on the anatomic studies of Braga-Silva. 7,8 They used the term predictable during the identification procedure. However, it is rather a vague report without any additional explanation.…”

Soft Tissue Reconstruction of the Hand

“…Finally, the adipofascial "turnover" flap is a reasonable option for coverage of full-thickness defects on the dorsum of the fingers. 7 This flap is based on constant dorsal cutaneous perforating vessels arising from the proper digital arteries at the level of the PIP joint. The flap may be extended to offer durable coverage to the entire digit from the PIP joint to the dorsal fingertip.…”