Dorsal Metacarpal Artery Flap Research Articles

Free vascularized metacarpal bone graft combined with extended dorsal metacarpal artery flap for phalangeal bone and soft tissue loss: case report

A 45-year-old man suffered from a complex bone and soft tissue defect of the middle phalanx of his left middle finger after an electric saw injury. Here, we present the patient's clinical and radiological outcomes after reconstruction with a free vascularized metacarpal II bone graft and an extended distally based second dorsal metacarpal artery skin flap (DMCA). To our knowledge, this is the first description of a free vascularized metacarpal bone graft combined with DMCA for distal finger reconstruction.

Foucher First Dorsal Metacarpal Artery Flap Versus Littler Heterodigital Neurovascular Flap in Resurfacing Thumb Pulp Loss Defects

Our study aims to illustrate the advantages and disadvantages of Foucher's first dorsal metacarpal artery flap and Littler's heterodigital neurovascular flap in thumb pulp reconstruction, by assessing wound healing of donor and recipient sites, sensibility, and functional outcome of the reconstructed thumb. Fourteen male patients were reconstructed either with Foucher (n = 8) or Littler flap (n = 6). Dissection of Foucher's flap was faster than that of Littler's flap. All Littler flaps survived completely, but we experienced 1 partial Foucher flap necrosis. Thumb motility and stability was optimal in all patients. Wound healing of donor sites was achieved in both groups. Two patients reconstructed with Littler flap developed scar contractures and presented a reduced range of motion of donor finger and first webspace, respectively. Although Littler flap resulted in better sensibility and tactile gnosis of the reconstructed thumb-pulp, Foucher flap ensured negligible donor site morbidity, complete cortical reorientation, and better overall hand function.

Use of Dorsal Metacarpal Artery Flaps in Post Burn Reconstruction - Two Cases Report

Perforator flaps based on the dorsal metacarpal arteries, islanded on a reverse flow pattern are used for reconstruction of two patients respectively with an unstable scar located on the MCP joints and a severe contracture of the ring finger, with full survival and excellent long term results.

Repair of digital soft tissue defects with a modified reversed island flap pedicled on a perforating branch of the dorsal metacarpal artery

Objective To report operative procedures and clinical results of repairing finger soft tissue defects with a modified reversed island flap pedicled on a perforating branch of the dorsal metacarpal artery. Methods From January 2005 to March 2008,we repaired 38 finger soft tissue defects in 31 patients (26 men and 5 women) with a modified reversed island flap pedicled on a distal perforating branch of the dorsal metacarpal artery and anastomosis of the cutaneous nerve.Their ages ranged from 14 to 66 years,with a mean of 29.6 years.Altogether 11 index,18 middle,6 ring and 3 little fingers were injured.Nine patients were complicated with rupture of tendons,3 with extenso-tendon defects and 5 with middle phalanx fractures.The defect areas ranged from 1.0 cm × 0.8 cm to 3.2 cm× 2.5 cm.The flap areas ranged from 1.2 cm× 1.0 cm to 3.5 cm× 2.8 cm.The flap did not carry a full length of the dorsal metacarpal artery but only the distal perforating branch of the artery.The rotating point of the flap pedicle was altered from the dorsal to the palmar side to extend the vessel pedicle.The donor sites were closed by suture or skin graft. Results Twenty-eight patients (35 fingers) were followed up for 3 to 25 months (mean,15.3 months) .All flaps survived with satisfactory appearance,sensation and function.All flaps and donor sites obtained primary healing.The two-point discrimination was 6 to 9 mm (mean,7.7 mm).According to Total Active Movement (TAM) evaluation system,the results were excellent in 20,good in 13 and fair in 2 fingers,with a good to excellent rate of 94.3％. Conclusion The modified reversed island flap pedicled on a distal perforating branch of the dorsal metacarpal artery and anastomosis of the cutaneous nerve is an easy,safe and effective treatment for finger soft tissue defects. Key words: Fingers; Soft tissue injuries; Dorsal metacarpal artery flaps; Repair

Modified super large dorsal metacarpal artery flap for reconstruction of circumferential fingertip avulsion

Objective To discuss the clinical outcome of the modified super large dorsal metacarpal artery flap in reconstruction of circumferential fingertip avulsion. Methods Twenty-four patients with circumferential fingertip avulsion were treated by the modified super large dorsal metacarpal artery flap from January 2004 to August 2008. There were six index fingers, 11 middle fingers, five ring fingers and two little fingers with surface defects beyond the distal interphalangeal joint and the distal degloving length ranged from 0.8 cm to 3.1 cm. Emergency operation was performed on 22 fingers and stage Ⅱ surgery was done for distal skin necrosis of two fingers. Results Twenty-one patients with 21 fingers were followed up for 6-28 months, which showed that all flaps survived, with satisfactory appearance and function, and that the point discrimination of flap was for 6-9 mm （ average 7.6 mm）. Conclusion Modified super large dorsal metacarpal artery flap is an ideal method for reconstruction of the circumferential fingertip avulsion with advantages of easiness, convenience and short treatment period. Key words: Finger injuries ; Surgical flaps ; Repair

Treatment of Thumb Tip Degloving Injury Using the Modified First Dorsal Metacarpal Artery Flap

Treatment of Thumb Tip Degloving Injury Using the Modified First Dorsal Metacarpal Artery Flap

Treatment of Thumb Tip Degloving Injury Using the Modified First Dorsal Metacarpal Artery Flap

This study reports repair of a thumb tip degloving injury using the modified first dorsal metacarpal artery (FDMA) flap, including both dorsal branches of the proper digital nerve (DBPDNs). From May 2006 to February 2008, the modified FDMA flap was used in 11 thumbs in 11 patients. All patients suffered a degloving injury to the thumb tip, and 4 had associated bone loss ranging from 1 to 3 mm (mean, 2 mm) in length. The size of the soft tissue defects was 2.6 to 4.6 cm (mean, 3.5 cm) in length and 1.8 to 2.2 cm (mean, 2.0 cm) in width. The flaps ranged in size from 2.7 × 2.2 cm to 4.8 × 2.1 cm (mean, 3.6 × 2.1 cm). The mean pedicle length was 7.2 cm (range, 6.8-7.5 cm). Neurorrhaphy between the DBPDN and the proper digital nerve was performed in both sides in all cases. Patient follow-ups ranged from 26 to 47 months (mean, 32 mo). Sensibility of the reconstructed thumb was evaluated by static 2-point discrimination. The range of motion of the donor fingers was measured. The data were compared to those of the opposite sides. All flaps survived completely. At the final follow-up, the mean values of static 2-point discrimination were 5 mm (range, 4-8 mm) and 6 mm (range, 4-8 mm) on the radial and ulnar sides of the distal portion of the flap, respectively. The mean values of the radial and ulnar distal portions of the flaps reached 75% and 72% of those of the opposite sides. The mean range of motion of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of the donor fingers were 73°, 101°, and 70°, respectively. The modified FDMA flap, including both DBPDNs, is useful for restoration of sensation on the thumb tip and maintenance of adequate length of the thumb. Therapeutic IV.

Preliminary outcomes of the modified first dorsal metacarpal artery island flap for soft tissue defects of the thumb

Objective To explore the survival rate and early-term effects of sensory reconstruction of the modified first dorsal metacarpal artery (FDMCA) flap in treatment of thumb distal soft tissue defect.Methods From March 2004 to October 2007, 65 patients with soft tissue defects of the thumb underwent the FDMCA flap in our department. Forty-nine cases with complete data were included in the study. There were 37 males and 12 females, with an average age of 32 years (ranged, 18-65 years). The conventional surgical methods were used in 18 cases while the improved surgical methods were in 31 cases. The distal necrosis, the vascular crisis rate and the sensory recovery were recorded. Results The mean follow-up period was 2 years (ranged, 20 months to 3 years). Forty-six flaps survived completely. Vascular crisis occurred in five cases harvested by the conventional methods. Eventually, three of them had a partial distal necrosis.Improved FDMCA flap survived well in all 31 patients. Flaps in these patients with nerve anastomosis restored satisfied sense and all sense were located in the thumb. Eighteen cases of nerve transfer group had different levels of mixed feelings (33%) or ectopic sensory (62%). Sense was located in the thumb completely in 1 case. Conclusion The modified FDMCA flap significantly increased the survival rate. Neurorrhaphy could make the sense of the flap locate in the thumb; however it had not been proved that its impact on the recovery of two-point discrimination and stereognosis. Key words: Hand injury; Thumb; Surgical flaps; Microsurgery

Dorsal Metacarpal Artery Flap for Resurfacing of Fourth-Degree Electrical Burns of Fingers

Dorsal Metacarpal Artery Flap for Resurfacing of Fourth-Degree Electrical Burns of Fingers

The use of reverse-flow dorsal metacarpal artery flaps after postburn metacarpophalangeal joint flexion contracture release

Abstract When thermal injuries of the hand are managed inappropriately, complex hand contractures are inevitable. Patients with hand contractures may have many difficulties in their daily life because of this deformity. These patients are challenging to reconstructive surgeons. In this study we evaluated reverse-flow dorsal metacarpal artery flaps for the defects occurred after metacarpophalangeal joint contracture release of different fingers. Nineteen patients with defects on the volar surface of metacarpophalangeal joint were reconstructed by the reverse-flow dorsal metacarpal artery flaps. All operations were successful and flap losses were not seen. The DMCA flaps provide one stage coverage and permit primary closure of the recipient site. The aesthetic and functional results are satisfactory without sacrificing main arteries. The only drawback is the residual scar on the dorsum of the hand, which can be treated by conservative means and may improve over time.

Second Dorsal Metacarpal Artery Flap From the Dorsum of the Middle Finger for Coverage of Volar Thumb Defect

The second dorsal metacarpal artery flap from the middle finger is a reconstructive technique that can be used to repair extensive volar defects in a normal-length thumb. However, few reports advocate using it for coverage of volar thumb defects. In this article, an anatomic study of 9 flaps used for resurfacing thumb defects is presented along with the clinical experience of the authors. From 2004 to 2006, 9 patients (6 men and 3 women; mean age, 33 years; range, 18-51 years) with extensive volar defects of their normal-length thumbs had reconstruction using the described technique. In all cases, the first dorsal metacarpal artery flap technique was unable to be used because of injury. Donor sites were covered using full-thickness skin grafts. After surgery, the thumb was immobilized with a splint, followed by rehabilitation. During the follow-up period, which lasted 24 to 30 months, flap-site skin quality, scar contractures, and finger mobility were assessed. The range of motion of the hand was measured by a goniometer. Sensibility was evaluated by the 2-point discrimination test and the Semmes-Weinstein monofilament test. Cold intolerance was also assessed. Patient postoperative courses were uneventful, and all flaps survived completely without complication. Good coverage was obtained in all cases. Full active range of motion was observed in all patients in both the donor finger and the thumb. The mean Semmes-Weinstein sensitivity and 2-point discrimination scores of the flap were 4.02 g and 8.4 mm, respectively. Mild cold intolerance was observed in all of the thumbs. The second dorsal metacarpal artery flap from the middle finger is a single-stage flap that produces good results. Although its pedicle length is limited, it is reliable and can be used as an alternative for reconstruction of extensive thumb-pulp defects, especially when the first dorsal metacarpal artery flap cannot be used. Therapeutic IV.

First dorsal metacarpal artery flap for thumb reconstruction: a retrospective clinical study

Extensive pulp (zone 4) defects of the thumb, with the exposure of tendon or bone, are challenging reconstructive problems. Surgical treatment includes the use of local, regional, and free flaps. The first dorsal metacarpal artery flap has been used successfully for defects of the thumb. The innerved first dorsal metacarpal artery flap from the dorsum of the index finger was first described by Hilgenfeldt and refined by Holevich. An island flap carried on a neurovascular pedicle consisting of the first dorsal metacarpal artery was first demonstrated by Foucher and Braun. Seven innervated FDMCA island flaps were performed from May 2005 until July 2007 for thumb reconstruction. There were three women and four men with an average age of 54.9 years (range 28–89 years). The mean follow-up period was 15.4 months (range 4–29 months). The dominant hand was involved in six (85.7%) patients. In a retrospective clinical study, the following criteria were evaluated: (1) etiology of the defect, (2) time of reconstruction (primary vs. delayed), (3) survival rate of flap, (4) sensory function (Semmes–Weinstein monofilaments, static 2-PD, pain, cortical reorientation), (5) TAM measured with the Kapandji index, and (6) subjective patient satisfaction (SF 36). Four patients presented with trauma, two patients with defects after tumor resection and one with infection of the thumb. The flap was used for immediate reconstruction in three (42.9%) patients and for delayed reconstruction in four (57.1%) patients. Delayed reconstruction was performed 4.75 (1–12) months after initial trauma or first surgery. The donor area was grafted with full-thickness skin grafts in all cases. All flaps survived. The mean SWMF was 3.31 g and average statis 2-PD over the flap was 10.57 mm. Pain at the flap scored 3.71 over 10 and at the donor site 2.17 over 10. Paresthesia at the flap scored 0.57 over 4 and at the donor site 0.33 over 4. Complete cortical reorientation was only seen in one patient. The mean Kapandji score of the reconstructed thumb was 7.43 over 10. Using the SF-36, mean physical health of the patients scored 66.88% and mean mental health scored 70.55%. Disturbing pain and paresthesia of the flap are exceptional. The static 2-PD is more than 10 mm, and is clinically over the limit. Cortical reorientation was incomplete in all but one patient. Touch on thumb is felt on the dorsum of the index finger; however, sensation is not disturbing or interfering with the patient’s activities. Foucher described the technique débranchement–rébranchement in order to improve this problem. The postoperative total amount of motion of the reconstructed thumb was very good. The results demonstrated that the FDMCA flap has a constant anatomy and easy dissection. It has a low donor site morbidity if FTSG is used. It also shows good functional and aesthetic results. Therefore, the FDMCA flap is a first treatment of choice for defects of the proximal phalanx and proximal part of the distal phalanx of the thumb.

First dorsal metacarpal artery islanded flap: A useful flap for reconstruction of thumb pulp defects

ABSTRACTThumb pulp defects are commonly due to avulsion injuries. It is very important to reconstruct these defects using sensate flaps as the thumb pulp needs to be sensate for implementing the various functions of the thumb. A very good option for coverage of these defects is the islanded first dorsal metacarpal artery flap. Our study was done over a period of 2 years and involved 9 consecutive cases of thumb pulp defects treated at our institution. The patients included 8 males and 1 female, ranging in age from 16 to 51 years old. The flap size ranged from 2 × 1.5 cm to 5 × 3 cm. We had only one complication in the form of partial flap necrosis, which fortunately healed following debridement without the need for a secondary procedure. All our cases were done under local anesthesia with tourniquet control. All the patients had good fine touch and average two-point discrimination of 6 mm, which was satisfactory. Our good results further reinforce the islanded first dorsal metacarpal artery flap as one the best flaps for sensate reconstruction of thumb pulp defects. It replaces the soft tissue loss at the thumb pulp with minimal donor site morbidity and with good return of thumb pulp sensation.

First dorsal metacarpal artery islanded flap: A useful flap for reconstruction of thumb pulp defects

Thumb pulp defects are commonly due to avulsion injuries. It is very important to reconstruct these defects using sensate flaps as the thumb pulp needs to be sensate for implementing the various functions of the thumb. A very good option for coverage of these defects is the islanded first dorsal metacarpal artery flap. Our study was done over a period of 2 years and involved 9 consecutive cases of thumb pulp defects treated at our institution. The patients included 8 males and 1 female, ranging in age from 16 to 51 years old. The flap size ranged from 2 × 1.5 cm to 5 × 3 cm. We had only one complication in the form of partial flap necrosis, which fortunately healed following debridement without the need for a secondary procedure. All our cases were done under local anesthesia with tourniquet control. All the patients had good fine touch and average two-point discrimination of 6 mm, which was satisfactory. Our good results further reinforce the islanded first dorsal metacarpal artery flap as one the best flaps for sensate reconstruction of thumb pulp defects. It replaces the soft tissue loss at the thumb pulp with minimal donor site morbidity and with good return of thumb pulp sensation.

Comments on foucher′s flap

Foucher’s flap is one of the ideal flaps to cover traumatic defect of the pulp and dorsum of the thumb. Though ideally described for thumb defects with some shortening, it has been proved beyond doubt that it can also be requisitioned to resurface thumb defects without shortening. In the latter indication, it is necessary to harvest the flap up to the dorsum of the PIP joint. However, the distal 1/3 of such a first dorsal metacarpal artery (FDMA) flap becomes a random part of the axial artery flap and hence carries some risk of marginal necrosis. It is surmised that the survival of such a flap is ultimately determined by the relative length of index and thumb. Normally, the tip of the adducted thumb roughly reaches upto 70% of the length of the proximal phalanx of the index finger (32% of the index finger length beyond MP joint); [1,2] such thumbs being ideally suited for conventional FDMA flaps. Individuals with thumb length more than 70% of the proximal phalanx of index finger are the ones likely to need an extended FDMA flap i.e. wherein flap is harvested beyond the PIP joint. One more ambiguous parameter of this flap is the amount of blood supply which comes alongwith the superficial branch of radial nerve. We know that every superficial nerve is accompanied by an artery and vein of its own supplying the skin and integument. Being a neuro-sensory flap, it is an ideal flap for pulp of thumb which restores an acceptable level of sensation, however, it may not match Littler’s neuro-vascular island flap because of poorer cortical reorientation. Kulkarni et al. [3] need to be congratulated for describing one more indication for FDMA flap. Though small traumatic defects on the radial side of the palm are rare, when encountered, this flap is really handy when compared to the alternatives. These flaps are also used in reconstructive surgeries following post burn scar contracture release, [4] syndactyly release, and partial loss of reimplanted thumb. [5] Donor-defect following this flap usually needs split skin graft or full-thickness skin graft. These usually do not give rise to functional deficit. Cosmesis, however, will be a consideration. This can be avoided if one harvests only adipofascial flap to cover

Hourglass Dorsal Metacarpal Island Flap: A New Design for Syndactylized Web Reconstruction

Web space reconstruction is the key point and an important component of syndactyly treatment. A design of the dorsal metacarpal artery flap was used as an island flap based on the direct cutaneous branch arising from the dorsal metacarpal artery at the distal end of the flap to reconstruct congenital web syndactyly. The flap rotated from 0 degrees to 180 degrees and passed under a skin bridge at the distal end of the flap to reach the web defect. Such design enables a better use of the skin territory from the intermetacarpal space proximal to the pedicle, with a short donor site scar and a more supple reconstruction of the web space.

Salvage of a Thumb Replant Using a Bilobed Dorsal Metacarpal Artery Island Flap: Case Report and Literature Review

Amputations and degloving injuries of the hand are highly disabling, especially when they affect the thumb. Dorsal metacarpal artery (DMCA)-based flaps have been well-documented in the literature for use in extensive degloving injuries of both dorsal and palmar aspects of the thumb surface. Modifications on these flaps, such as the bilobed island flap, offer additional advantages when larger surface areas or more distal defects of the thumb are present. We present a review of the literature on the DMCA flap and describe its use to salvage a partial survival of a thumb amputation through the metacarpophalangeal joint.

The evolution and refinements of the distally based dorsal metacarpal artery (DMCA) flaps

Distally based DMCA flaps are well established in reconstructive hand surgery. They comprise the dorsal flap described by Quaba and the DMCA flaps described by Earley, Milner and others. The most frequent indications for these flaps are soft tissue defects of the dorsum of the proximal phalanx and the total length of the finger. Since its introduction several modifications have been developed to match specific defect requirements; these include: the development of pure fascial DMCA flaps, the use of DMCA flaps in dorsally grafted burned hands and modifications in design to avoid 'tunnelling' and to permit skin-skin defect closure. The purpose of this article is to provide an overview of the evolution and refinements of the DMCA flaps based on the experience of a single centre. The DMCA flaps provide one stage coverage of excellent quality with independent vascularisation and permit primary closure of the recipient site without sacrificing relevant arteries (e.g. proper digital artery). However, the DMCA flaps also possess drawbacks, for example, apart from the fact that this technique is quite demanding, possible hair growth and a visible scar on the exposed dorsal part of the hand present aesthetic problems for some patients. Despite these limitations, DMCA flaps are considered to be extremely useful.

Reverse Second Dorsal Metacarpal Artery Flap for Reconstruction of Fourth-Degree Burn Wounds of the Hand

We sought to show how severe soft-tissue injuries of the proximal index finger caused by fourth-degree electrical burns to the hand may be surgically reconstructed. Soft-tissue coverage was provided with a reverse second dorsal metacarpal artery flap in two patients. Both digits were successfully salvaged by use of this reconstructive method. Both donor sites were closed primarily and healed without difficulty. The reverse second dorsal metacarpal artery flap provides well-vascularized tissue without excess bulk and allows near-normal hand function.

Neurovaskuläre Lappen zur Rekonstruktion von Fingerendglieddefekten

The fingertip is an extremely specialized end organ with a highly developed sense of touch. In this article, we present the different ways of reconstructing a traumatized fingertip. Additionally, we systematically explain the differential indications for the different techniques available. The whole spectrum of fingertip reconstruction is discussed, starting from local neurovascular flaps (palmar VY-Atasoy flap, Kutler flap, palmar Moberg flap, lateral Venkataswami and Subramanian flap, palmar Hueston flap), distant flaps (Littler flap, Foucher flap, dorsal metacarpal artery flap, cross-finger flap, reversed cross-finger flap) and finally free flap transfer (free toe-pulp transfer, spare-part transplantation). The advantages and disadvantages of each flap are highlighted. We develop an algorithm to facilitate finding the correct type of reconstruction.