Hình 3-5. Homodigital adipofascial lòng bàn tay vỗ. (Voche P, Merle M. dưới da homodigital nắp bao gồm các khuyết tật ngón tay lưng Br J Plast Surg 1994; 47 (6): 435-439 Bản quyền (1994), với sự cho phép của Hiệp hội Anh của bác sĩ phẫu thuật nhựa) | Advanced Concepts in Vascularized Tissue Transfer in the Hand 27 4 Dorsal tissue loss Grayson s ligament Subcutaneous flap b Split thickness skin graft c Cleland s ligament Areas of pedicle release- Dermo-epidermal flap a Figure 3-5. Homodigital adipofascial palmar flap. Voche P Merle M. The homodigital subcutaneous flap for cover of dorsal finger defects. BrJPlast Surg. 1994 47 6 435-439. Copyright 1994 with permission from The British Association of Plastic Surgeons. Variations of Random-Pattern Flaps Another option to cover a dorsal defect of the finger is a homodigital adipofascial palmar flap as described by Voche and Merle Figure 3-5 .31 50 In anatomic studies they documented the vascular supply of the palmar subcutaneous tissue and they use this layer as a turnover flap to cover dorsal defects. This flap definitely has potential but very delicate dissection is required to preserve the paratenon of the flexor tendons and to avoid injuring the neurovascular bundle. Flaps With Axial-Pattern Perfusion Axial-pattern flaps are characteristically based on a defined vessel that independently perfuses the area of the flap either directly or through perforating branches. The design of axial island flaps most frequently used as digital or dorsal metacarpal flaps varies substantially from that of a local transposition flap. The size of the flap should match the size of the defect with only a slight overcorrection. Most surgeons design the skin island slightly larger to avoid any tension on the flap. This is usually tolerated by the flap. Flaps that are too large for the defect may result in venous congestion rather than in additional safety to the flap. The arc of rotation which is determined by the length of the pedicle is of utmost importance for the success of an axial island flap. It is even more important in reverse pedicle flaps. Antegrade flaps usually do not exceed an arc of rotation of 90 to 120 which greatly reduces the risk of kinking. Reverse pedicle flaps .
