Different distal-based dorsal metacarpal flaps for repair of soft tissue defects of the finger

Abstract

Objective To explore the application of dorsal metacarpal flaps based on different distal pedicles for repair of soft tissue defects of the fingers. Methods From June 2008 to May 2009,soft tissue defects of 45 fingers in 37 patients were repaired by distally-based retrograde dorsal metacarpal flaps.Among these dorsal metacarpal flaps,29 were pedicled on the finger web perforator,and 16 were pedicled on the dorsal perforator of the digital artery. Results Forty-one flaps survived uneventfully.Minor blood circulation compromise was noted in 4 flaps.The situation was salvaged by removing a couple of stitches at the distal portion of the flaps.These flaps survived and healed as well.Postoperative follow-up was sufficient in 37 cases,ranging from 10 to 24 months.All repaired fingers had satisfactory appearance and good function.The outcomes were graded as excellent in 30 cases,good in 5 cases,fair in 2 cases,and the good and excellent rate of finger function reached 94.6％ according to the provisional functional assessment criterion for upper limbs issued by the Hand Society of Chinese Medical Association. Conclusion The blood circulation of dorsal metacarpal flap is commonly supplied by dorsal metacarpal artery perforators and dorsal metacarpal cutaneous nerve nutrient vessels,which anastomose widely around the metacarpophalangeal joint and the proximal phalanx.This provides the options of different distal pedicles which can be selected for flap design to effectively meet the needs of wound coverage of the fingers. Key words: Island flaps; Finger injuries; Surgical procedures,operative