Coverage of elbow and forearm soft tissue defects with the posterior ulnar recurrent artery perforator flap (PURAP): an anatomical study.

IF 1.4 4区 医学 Q2 Medicine
Elise Lupon, Hadrien Paoli, Yanis Berkane, Nicolas Bertheuil, Jean Baptiste De Villeneuve Bargemon, Olivier Camuzard, Isabelle Pluvy, Benoît Chaput
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Abstract

Introduction: Covering soft tissue defects from the elbow and forearm is challenging for the plastic surgeon. The posterior ulnar recurrent artery perforator flap is a fasciocutaneous perforator flap vascularized by the perforators emerging from the posterior ulnar recurrent artery. It has multiple functional and aesthetic advantages but has not yet been well studied. This work aimed to examine the number, caliber, and topography of the posterior ulnar recurrent artery's perforators.

Methods: Perforator mapping was performed by blue latex injection on 20 fresh cadavers' upper extremities. Thermal mapping by TIRD was used to identify the "hot spots" of these perforators, and the 4D vascular network of the ulnar recurrent artery was scanned. The preoperative design and dissection of the flap were adapted based on the results of this anatomical study. A case study was performed to illustrate the clinical application.

Results: On average, we located 7.7 ± 1.7 perforators per upper extremity with an average caliber of 0.77 ± 0.19 mm (3.5 ± 1.2 in the forearm and 4.2 ± 1.5 in the arm). On average, the arm perforators were located 3.2 ± 1.6 cm proximally from the medial epicondyle. Thermal mapping showed three perforator "hot spots," two in the forearm (directly at the artery origin level and one more posteriorly) and one in the arm. The 4D CT reconstructions allowed us to estimate the vascular territory at the level of the medial epicondyle and the distal half of the medial aspect of the arm, as well as the ascending course of the artery.

Conclusion: The posterior ulnar recurrent artery perforator flap can be harvested efficiently and reliably, as the posterior ulnar recurrent artery has constant perforators, especially around 3 cm proximal to the medial epicondyle. This reinforces this flap's status as a potential elbow and forearm tissue defect coverage alternative.

尺后再动脉穿支皮瓣覆盖肘部及前臂软组织缺损的解剖学研究。
对整形外科医生来说,覆盖肘部和前臂的软组织缺损是一个挑战。尺后再动脉穿支皮瓣是由尺后再动脉穿支血管构成的筋膜皮肤穿支皮瓣。它具有多种功能和美学优势,但尚未得到充分研究。这项工作的目的是检查的数量,口径,和地形的后尺复发动脉穿支。方法:对20例新鲜尸体上肢进行蓝色乳胶注射穿支定位。利用TIRD热成像技术识别这些穿支的“热点”,并扫描尺侧复发动脉的4D血管网络。术前设计和解剖皮瓣是根据解剖研究的结果进行调整的。并以个案研究说明其临床应用。结果:我们平均每条上肢定位7.7±1.7个穿支,平均口径为0.77±0.19 mm(前臂3.5±1.2 mm,手臂4.2±1.5 mm)。臂穿支平均位于距内侧上髁近端3.2±1.6 cm处。热成像显示三个穿支“热点”,两个在前臂(直接在动脉起源水平,一个在后方),一个在手臂。4D CT重建使我们能够估计内侧上髁水平和臂内侧远端一半的血管范围,以及动脉的上升路线。结论:尺后返动脉穿支皮瓣在尺后返动脉内上髁近3 cm处有固定的穿支,可有效、可靠地切除。这加强了皮瓣作为肘部和前臂组织缺损覆盖的潜在选择的地位。
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来源期刊
Surgical and Radiologic Anatomy
Surgical and Radiologic Anatomy Medicine-Pathology and Forensic Medicine
CiteScore
2.40
自引率
14.30%
发文量
0
期刊介绍: Anatomy is a morphological science which cannot fail to interest the clinician. The practical application of anatomical research to clinical problems necessitates special adaptation and selectivity in choosing from numerous international works. Although there is a tendency to believe that meaningful advances in anatomy are unlikely, constant revision is necessary. Surgical and Radiologic Anatomy, the first international journal of Clinical anatomy has been created in this spirit. Its goal is to serve clinicians, regardless of speciality-physicians, surgeons, radiologists or other specialists-as an indispensable aid with which they can improve their knowledge of anatomy. Each issue includes: Original papers, review articles, articles on the anatomical bases of medical, surgical and radiological techniques, articles of normal radiologic anatomy, brief reviews of anatomical publications of clinical interest. Particular attention is given to high quality illustrations, which are indispensable for a better understanding of anatomical problems. Surgical and Radiologic Anatomy is a journal written by anatomists for clinicians with a special interest in anatomy.
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