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Cutaneous Perforators and Their Clinical Implications on Intrinsic Hand Flaps: A Systematic Review.

Theddeus Octavianus Hari Prasetyono1,2,3, Clara Menna4

  • 1Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital/Faculty of Medicine, Universitas Indonesia.

Plastic and Reconstructive Surgery. Global Open
|April 27, 2022
PubMed
Summary

This review details hand perforator anatomy for intrinsic hand flaps. Understanding these cutaneous perforators enables versatile flap designs for reconstructive surgery.

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Area of Science:

  • Anatomy
  • Plastic Surgery
  • Reconstructive Surgery

Background:

  • Local intrinsic flaps are common in hand surgery due to small, fragile hand perforators.
  • A comprehensive review of anatomical data on hand cutaneous perforators is needed.
  • Implications for intrinsic hand flap design require further investigation.

Purpose of the Study:

  • To compile anatomical data on cutaneous perforators of the hand.
  • To analyze the implications of this data for intrinsic hand flap design.
  • To provide a foundation for improved surgical techniques in hand reconstruction.

Main Methods:

  • Systematic electronic literature search across major databases (PubMed, Scopus, etc.) in April 2021.
  • Inclusion of studies based on PRISMA guidelines and critical appraisal using QUAC and AXIS tools.
  • Analysis of anatomical and clinical data from 33 selected studies involving 643 hands and 406 fingers.

Main Results:

  • Identified consistent, well-distributed perforators in specific hand regions: dorsal hand, dorsal digits, hypothenar, midpalm, thenar, and dorsal wrist.
  • Perforators in these areas are characterized by small diameters and short pedicle lengths.
  • Clinical studies confirm the successful elevation of local perforator flaps in these regions.

Conclusions:

  • The hand possesses a dense network of interconnected cutaneous perforators with variable sizes and pedicle lengths.
  • Existing anatomical knowledge supports the creation of diverse intrinsic hand flap designs.
  • Further exploration of unexplored hand areas may reveal additional reconstructive possibilities.