title: Surgical refinements and sensory recovery of using transverse sensate thoracodorsal artery perforator flaps to resurface ring-avulsed fingers.
abstract: To improve the use of thoracodorsal artery perforator flaps in resurfacing ring-avulsed fingers, the relations between the thoracodorsal artery perforators and intercostal nerves were investigated. The surgical refinements, clinical results, and sensory recovery of flaps were presented. Eleven patients with ring-avulsed fingers were reviewed. Separated and conjoint relations were found. Eleven flaps were harvested with 3 refinements. First is the transverse flap design. Second is operating color Doppler sonography to identify the relations. Third is using the conjoint relation to facilitate adequate flap thinning. Four patients had separated relation, and 7 patients had conjoint relation. Only 1 patient showed flap tip necrosis. Two patients with separated relation needed flap debulking. Ten patients acquired protective to normal tactile sensation, and 9 patients gained fair to normal discriminative sensation. The free transverse sensate thoracodorsal artery perforator flaps can be an option in the reconstruction of ring-avulsed fingers.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; and †National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Cheng-Ta
authors.initials: CT
authors.lastname: Lin
authors.forename: Lee-Wei
authors.initials: LW
authors.lastname: Chen
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery; D002648:Child; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005385:Fingers / Q000098:blood supply; D006801:Humans; D007367:Intercostal Nerves / Q000637:transplantation*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009416:Nerve Regeneration / Q000502:physiology; D061525:Perforator Flap / Q000098:blood supply* / Q000294:innervation* / Q000601:surgery*; D012086:Reoperation; D012092:Replantation; D012677:Sensation / Q000502:physiology*; D017695:Soft Tissue Injuries / Q000601:surgery*; D013895:Thoracic Arteries / Q000601:surgery; D013933:Thumb / Q000098:blood supply / Q000293:injuries / Q000601:surgery; D020858:Tissue and Organ Harvesting / Q000379:methods; D014110:Touch / Q000502:physiology; D017211:Treatment Failure; D018615:Ultrasonography, Doppler, Color