Use of Reverse Second Dorsal Metacarpal Artery Flap for the Treatment of First Web Retraction

Abstract

Objective: To describe and present the results of surgical technique with the use of skin flap of second dorsal metacarpal artery retrograde flow to the treatment of patients with retraction of the first web space of the hand and, when necessary, apply longer flaps to cover the palm of the hand. Methods: Sixteen patients were operated with retraction of the first web space. In 6 patients, there was also scar retraction of the palm, in addition to the web space. Before surgery, the angle of opening of the first web space was measured, and the degree of shrinkage was divided into 3 groups: mild, moderate, and severe. Eleven cases were considered serious and 5 moderate. The authors describe in detail the surgical technique. Results: All 16 flaps had survival (100 cases). In 3 cases, there was partial suffering of about 10% of the distal area of the flap with transient ischemia and in 2 cases epidermolysis occurred, all with satisfying results. Retail dimensions ranged on average 10 cm in length and 2.2 cm in width, on average. In 87.5% of the cases there was total closure of the donor area. The opening of the first commissure ranged from 51° to 83° (average of 73.5°). Conclusion: The use of the cutaneous flap of the second metacarpal dorsal artery is reliable and it shows good results for the treatment of retractions of the first web space. It can be considered a good option for cases that present beyond the web space, retraction of the palm.