Colgajo perforante de la segunda arteria metacarpiana dorsal: Estudio anatómico en cadáveres y experiencia clínica

Resumen

Introducción Los defectos de cobertura de la mano y de los dedos de tamaño moderado son frecuentes y representan un reto para el cirujano reconstructivo. Existen varias opciones locales disponibles, y el conocimiento de la anatomía vascular de la zona nos ofrece nuevas posibilidades de cobertura.

Material y métodos Se realizó un estudio anatómico en 13 extremidades de cadáveres frescos, describiendo las perforantes cutáneas en el tercio distal de la segunda arteria metacarpiana dorsal. Se presenta adicionalmente nuestra experiencia clínica inicial con el uso del colgajo perforante metacarpiano dorsal en siete casos.

Resultados De forma consistente se encontró en todos los cadáveres la presencia de perforantes distales, y la ausencia de la juntura tendinae, lo que obliga a usar la cabeza del metacarpiano como límite para el punto pivote del colgajo en nuestra población, a diferencia de las descripciones anatómicas previas. En la serie de casos clínicos, el colgajo logró resolver adecuadamente todos los defectos, y se presentó solo un caso de necrosis parcial.

Conclusión Luego del seguimiento de los casos clínicos reconstruidos con ese colgajo, se evidencia su versatilidad, anatomía vascular confiable y baja tasa de complicaciones, convirtiéndolo en una opción de primera línea para la cobertura de defectos digitales.

Abstract

Introduction Hand and digital soft tissue defects of considerable size are very common and represent a challenge for the reconstructive surgeon. There are several local options available, and the knowledge of the local vascular anatomy brings us new possibilities for coverage.

Material and Methods An anatomic study was done in 13 hands, describing the distal cutaneous perforators of the second dorsal metacarpal artery. In addition, we present our initial clinical experience using the dorsal metacarpal artery perforator flap in 7 cases.

Results We consistently found over the distal third cutaneous perforators of the dorsal metacarpal artery, as well as the absence of the juntura tendinae,suggesting that in our population the anatomic mark for the pivot point for the flap should be the metacarpal head, in contrast to previous anatomical descriptions. All flaps we were able to solve all injuries and there was only one case of partial necrosis.

Conclusion After final follow-up of the clinical cases using this flap, is evident its versatility, reliable vascular anatomy and low rate of complications. It can be considered as a first line option for soft tissue coverage of digital defects.

Palabras clave

perforantes cutáneas - colgajo perforante arteria metacarpiana dorsal - defecto cobertura digital

Keywords

cutaneous perforators - dorsal metacarpal artery perforator flap - soft tissue digital defects

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