METHOD FOR PLASTIC REPLACEMENT OF TERMINAL DEFECTS IN SOFT TISSUES OF THE FIRST FINGER

摘要

The method for the plastic replacement of the defects in the soft tissues of the first finger comprises the generation and the mobilization of the flap cut out of the skin and the subcutaneous fat at the level of the second metacarpophalangeal joint on the radial edge, the precise separation of the neurovascular bundle in proximal direction to the "anatomical box", the passage of the flap through the subcutaneous tunnel to the recipient bed. The peduncle of the flap is generated by the first metacarpal artery with the dorsal surface branch of the radial nerve. The autodermoplasty of the donor wound is performed employing the dermal autologous graft embracing all layers. The graft is sutured around to the skin of the finger and "pelot" is applied. The insular flap is separated from the dorsolateral surface of the hand. The flap comprises the dorsal branch of the radial nerve used for reinnervation of the flap with the donor digital nerve of the finger. The retrograde blood flow in the insular flap is provided by the anastomoses of the first metacarpal artery with the medial dorsal artery of the first finger. The latter in its turn anastomoses with the lateral dorsal artery of the first finger and the digital arteries of the palm. The flap is sparsely fixed to the edges of the defect using the non-traumatic suturing material (Nylon 4/0). The donor wound is sewed into line withouttension for preventing the vascular peduncle from being compressed at the site of the origin. The peduncle is covered by the autologous dermal graft embracing all layers. The pelot is not applied. The surgery is performed using the microsurgical instruments under the microscope providing for the minimal traumatization of the surrounding tissues. Upon the surgery, the aseptic bandage is applied.