The First Dorsal Metacarpal Artery Flap Family: A Review.

Zaira Manteiga,Guillermo Menendez,Marta De Prado,Jose Couceiro

doi:10.1055/s-0038-1675369

Abstract

Deep soft tissue injuries around the thumb can severely hinder hand function if not treated correctly. Many different surgical options have been described for the treatment of these serious lesions, including microsurgical flaps, such as toe to hand flaps, local flaps, and distant pedicled flaps. The first dorsal metacarpal artery family of flaps belongs to this last category. These flaps can be performed in different ways, as a racquet, as an island flap, and as a bilobed flap including the second metacarpal artery, among others.The aim of the following article is to review the basic concepts involved in the use of these flaps in reconstructive hand surgery.

Highlights

Deep soft tissue injuries around the thumb can severely hinder hand function if not treated correctly
The first dorsal metacarpal artery family of flaps belongs to this last category
The first dorsal metacarpal artery (FDMA) family of flaps consists of several different pedicled flaps which rely on the use of the FDMA, alone or in combination with the second dorsal metacarpal artery.[1,2,3,4,5,6,7,8]

Summary

Surgical Anatomy

The first dorsal metacarpal artery has been found to be quite constant. Sherif[1] differentiated three different vascular patterns for the terminal fascial branches of the FDMA (►Fig. 1). Most of the flaps on the FDMA family are based on the ulnar branch (FDMAu) This ulnar branch ends as a vascular plexus over the dorsal fascia of the index finger. According to Tellioglu and Sensöz,[3] the terminal sensitive branches of the radial nerve are present at the dorsum of the index finger, at the area of the proximal phalanx, lying just beneath the skin. In their dissections they always found a dorsal branch of the digital nerve (►Fig. 2) which was deeper than the radial nerve branches, lying just over the extensor apparatus, and ending as three terminal branches on the area of the middle phalanx. This dorsal nerve branch can be sacrificed to add innervation to the flap if necessary.[4,5]

Indications and Contraindications

Surgical Technique

Tips and Tricks

Pitfalls and Complications