The first dorsal metacarpal artery flap: A practical operation for thumb reconstruction

Abstract

Objective: To present six cases treated with kite flap for thumb reconstruction and to discuss important aspects of the first dorsal metacarpal artery (FDMA) flap technique along with the pertinent literature. Method: We evaluated the age, etiology, operation time, and postoperative flap necrosis of six patients who had undergone thumb reconstruction with FDMA flap between 2014 and 2017. All patients signed a written informed consent form. A) Relevant anatomy: The FDMA is a branch of the radial artery. It supplies the dorsal aspect of the index finger up to the proximal interphalangeal (PIP) joint. The artery is located in the groove between radial of the body of the second metacarpal bone and the ulnar head of the first interosseous muscle. B) Flap design and surgical technique: The proximal and distal borders of the flap were constituted from the metacarpophalangeal (MCP) and PIP joints, respectively. Flap elevation was performed from the distal to proximal direction and from the ulnar to radial side. Results: The average patient age was 46.8 years. Five patients underwent surgery due to trauma and one patient underwent surgery due to a painful scar on the tip of the thumb. For the five trauma patients, thea verage operation time was 1.4 days. The patient with the painful scar had sustained the trauma 15 years ago. Flap necrosis was not observed. The average postoperative follow-up duration was 1.6 years. Conclusion: The FDMA flap is a safe and practical solution for thumb reconstruction provided that the anatomy of the FDMA is well known and proper technique is used.