Dorsal Metacarpal Artery Island Flap Research Articles

Restoration of Sensibility Following Reconstruction of Soft Tissue Defect of Thumb with the First Dorsal Metacarpal Artery Island Flap

Introduction: Thumb injuries constitute a challenge for the plastic surgeon because the loss of its function compromises the function of the entire upper limb. If there is a soft tissue defect in thumb where tendons, joints, or bones is exposed, it requires stable vascularized flap reconstruction preferably with a local or regional flap. The First Dorsal Metacarpal Artery (FDMA) island flap from the dorsum of the index finger is an option for reconstructing such thumb defect. Objectives: To assess the quality of sensitivity at flap site following reconstruction of soft tissue defect in thumb with the FDMA island flap. Materials and Methods: A prospective observational study was conducted from July 2012 to June 2013 among 31 patients admitted with soft tissue defect of thumb with exposure of tendon, bone, joint or loss of pulp and were treated with innervated FDMA island flap. Recovery of sensation was evaluated by static-2PD test. Results: Out of 31 patients 28 were male and 3 were female with male to female ratio is 9:1. The mean age was 26.2±8.8 years. A large number of patient was manual worker (construction worker, mechanic). Most of them sustained injury in their dominant thumb (61%). Most common cause of injury was electric burn (78%) rest were due to machinery injury. Average s-2PD over the flap area 9.1 mm (range, 8-12 mm) compared with 7.4 mm (range, 7-11 mm) over the donor site of opposite index finger and 5.5 mm (range, 3-9 mm) over corresponding site of opposite thumb. Average loss of s-2PD over the flap area compared with the donor area was 1.4 mm (19.2%). Every patient was satisfied with the outcome. Conclusion: Restoration of sensibility is quite satisfactory after reconstruction of soft tissue defect of thumb by first dorsal metacarpal artery island flap. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 34-38

Functional and aesthetic outcomes of first dorsal metacarpal artery flap for thumb reconstruction: a prospective study

Background: Reconstruction of soft tissue defects of the thumb, with exposure of tendon, joint or bone, has been a challenging problem. Surgical options include local, regional or free flaps. Here, we have evaluated the functional and aesthetic outcomes of first dorsal metacarpal artery (FDMA) island flap in reconstruction of various soft tissue defects of the thumb.Methods: Between January 2018 and January 2019, twenty patients with post-traumatic and post-infective thumb defects underwent FDMA flaps. Sensory function was evaluated with static 2 point discrimination and mobility of the thumb was tested by the Kapandji score. The aesthetic outcome was also assessed.Results: The mean defect size was 39.9×19.95 mm. Eighteen flaps survived completely and one had distal flap necrosis and one had superficial epidermal peeling which was treated conservatively. The mean static two-point discrimination was 9.3 mm. Cortical reorientation was complete in 45%. The average Kapandji score was 7.9. The aesthetic outcome was excellent in ten, good in eight and poor in two subjects. After a mean follow up period of 11.85 months, most patients regained all functions of the thumb and index finger and were pleased with the cosmetic appearance of the flap and donor site.Conclusions: FDMA flap offers a good quality skin cover for small to moderate sized thumb defects. It is a reliable and versatile flap which is sensate and pliable. It gives excellent functional and aesthetic outcomes with minimal or no donor site morbidity.

Soft tissue reconstruction of low voltage electric burn injuries of the thumb and first web space by the first dorsal metacarpal artery island flap: a three-year study from Eastern India

Background: Complex soft tissue defects of thumb and first web space are a reconstructive challenge. Low voltage electric burns of the hand commonly result in localised and deep soft tissue destruction. The first dorsal metacarpal artery flap (FDMA) is an attractive local flap option to reconstruct these. This study illustrates our experience with the same.Methods: Between March 2014 and February 2017, 16 patients with complex soft tissue defects of thumb and first web space resulting from low voltage electric burns underwent reconstruction with the FDMA flap and subsequent structured hand therapy. In the follow up visits objective assessment of hand function included tests of mobility using Kapandji Score, sensory evaluation with static 2 point discrimination and cortical reorientation. The Subjective Satisfaction Score was used to ascertain the patient’s overall perception of aesthetic and functional outcome.Results: Majority (43.75%) of the patients had defects involving the thumb IP joint. No case of complete flap failure was noted. In a mean follow-up of 11.5 months the reconstructed thumb showed return of good protective sensation as well as mobility. Though cortical reorientation was complete in only 18.75 %, it did not substantially impede hand functioning. All patients were satisfied with the functional and aesthetic result.Conclusions: In cases of low voltage electric burn injuries the FDMA flap is a reliable reconstructive option for small to moderate sized complex defects of thumb and first web space. It has minimal donor site morbidity and can be accomplished in a relatively simple single stage procedure.

Clinical application of modified dorsal island flap of index finger for repairing the soft tissue defect of thumb tip

Objective To investigate the therapeutic effect of modified dorsal metacarpal artery island flap of index finger without skin graft in repairing different types of soft tissue defect of thumb tip. Methods From August, 2015 to October, 2017, 25 patients with soft tissue defect of the thumb tip were included in the study. Sixteen cases were males and 9 cases were females. Seventeen defects were in thumb dorsal and 8 cases were in thumb pulp. A modified dorsal island flap of index finger was used and the dorsal metacarpal superficial vein fascial flap could be harvest and combined to repair the thumb pulp defect if necessary. A relaying perforator flap pedicled on the second dorsal metacarpal artery was raised through the same incision to cover the donor site without skin graft. Followed-up was made by clinic, telephone and WeChat. Results The patients were followed-up for 6 to 18 months. All flaps survived completely without complications. The color, texture and contour of the flaps was good. Only 1 linear scar was left in the dorsum of the hand and no skin grafts. The second dorsal metacarpal artery flap was used to cover the donor site. Twenty-one cases (84%) were satisfied with the postoperative appearance of the thumb. The function was assessed as excellent in 16 fingers, good in 6 fingers and fair in 3 fingers. No complication occurred in the donor site. Conclusion It is possible to use the modified dorsal island flap of index finger to repair different types of thumb tip defects. A second dorsal metacarpal artery flap can be used as a relaying flap to cover the donor site without skin grafts. Key words: Thumb tip; Index finger; Island flap; Surgical modification; Microsurgical technique

Evaluation of versatility of use of island first dorsal metacarpal artery flap in reconstruction of dorsal hand defects

Posttraumatic dorsal hand defects with exposed tendons and/or bones represent a challenge to reconstructive surgeons. Many options are suggested ranging from local, regional, distant up to free flaps. First dorsal metacarpal artery island flap was commonly prescribed for reconstructing the thumb or first web space defects. During a 30 month's period, 23 patients, 15 males aged between 17 and 48 years and 8 females aged between 18 and 36 years presented by posttraumatic dorsal hand defects. Ofthem 18 had both exposed tendons and bones while 5 had exposed tendons only. The defects dimensions ranged between 3×4cm and 4.5×6cm. All defects were reconstructed by using a single stage first dorsal metacarpal artery island flaps. All flaps survived completely without complication during the mean follow up periodof 2 years. All patients were very satisfied both functionally and aesthetically by the procedure. Island first dorsal metacarpal artery flap is a good option for reconstructing mild to moderate dorsal hand defects with acceptable functional and cosmetic results.

Modified first dorsal metacarpal artery island flap for sensory reconstruction of thumb pulp defects.

Restoration of tactile sensation after reconstruction of a thumb pulp defect is import for hand function. We describe our clinical experience using a modified first dorsal metacarpal artery island flap innervated by the radial dorsal branch of the proper digital nerve and the terminal branch of the superficial radial nerve in 20 consecutive cases. The results were compared with 25 patients treated by the conventional Foucher's first dorsal metacarpal artery flap without nerve repair. At the final follow-up, flap sensation was assessed using static two-point discrimination and Semmes-Weinstein monofilament testing. All flaps survived uneventfully in both groups. At the final follow-up, the mean values for static two-point discrimination and Semmes-Weinstein monofilament testing in the study group were significantly different from the values in the control group. The modified first dorsal metacarpal artery island flap provides a reliable and simple option for sensory reconstruction of thumb pulp defects. Therapeutic, level III.

Workhorse Flaps for Soft Tissue Coverage in the Hand

Soft tissue defects of the hand are frequent and can be due to a variety of causes, including trauma, infection, and tumor. Numerous flaps have been described for the coverage of these defects but in our hands we have found 3 flaps capable of providing coverage for the majority of hand defects; these flaps include the first dorsal metacarpal artery island flap, the heterodigital island flap, and the radial forearm flap (with its variations, including perforator-based and fascia-only flaps). This article will provide an overview of the surgical technique required for successful usage of these 3 flaps.

The innervated first dorsal metacarpal artery island flap for reconstruction of post-traumatic thumb defect

Background Various surgical techniques contribute to repair distal defects of the fingers, especially the thumb as traumatic loss diminishes or eliminates the thumb prehensile abilities and may affect overall hand function.

Use of a Bilobed Second Dorsal Metacarpal Artery-Based Island Flap for Thumb Replantation

An extensive traumatic defect at the level of the proximal phalanx of the thumb presents difficulty in replantation. We report bilobed second dorsal metacarpal artery-based island flap harvested from both the index and middle fingers for reconstruction of the defect and preservation of the normal thumb length. From March 2004 to October 2008, 15 patients (11 men and 4 women; mean age, 35 y; range, 18 to 55 y) with completely or incompletely amputated thumbs associated with extensive defects in the proximal phalanx had replantation and reconstruction. In all cases, a bilobed second dorsal metacarpal artery-based island flap was used due to the large size of the defect. After flap transfer, anastomoses between the veins of the distal part of the thumb and the flap were performed. At the final follow-up, we assessed the mean active range of motion of the metacarpophalangeal and interphalangeal joints of the thumb and the span of the first web in the thumbs that survived. Active motion of the donor fingers was also assessed. In this series, 13 thumbs survived and 2 failed. All flaps survived completely. At the mean follow-up of 27 months (range, 24 to 29 mo), the mean active motion arcs of metacarpophalangeal and interphalangeal joints were 32° (range, 15° to 45°) and 31° (range, 0° to 47°), respectively. Full active range of motion was observed in all patients in both the metacarpophalangeal and the proximal interphalangeal joints of the donor index and middle fingers. Bilobed second dorsal metacarpal artery-based island flap transfer is a useful and reliable technique for thumb replantation when there is an extensive defect in the proximal phalanx and when a single-digit dorsal metacarpal artery island flap is too small. 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

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.

An Alternative Approach in the Treatment of Dupuytren's Contracture Skin Defects: First Dorsal Metacarpal Artery Island Flap

Skin defects are often present following surgery for Dupuytren's contracture. The first dorsal metacarpal artery island flap (FDMA) has been used by others for soft tissue reconstruction about the radial and dorsal aspect of the hand, thumb and fingers. We have used it successfully to fill the skin defects often seen following palmar fasciectomy for Dupuytren's contracture. The thin nature of the flap makes it suitable for this application. The FDMA arises from the radial artery just before the radial artery enters the first dorsal interosseous muscle and divides into three branches: 1 to the thumb, 1 to the index finger (radiodorsal branch) and a muscular branch. It is the radiodorsal branch that supplies the skin over the index finger. The island flap based on this artery includes the dorsal terminal branches of the radial nerve and venae comitantes. The flap is formed to include the fascia of the first dorsal interosseous muscle to avoid injury to a possible deep artery and to yield sufficient fat to promote venous drainage. The flap is passed subcutaneously through the first web space and sutured in place to cover the skin defect in the palm. A full thickness skin graft is used to cover the defect over the proximal phalanx of the index finger.

Restoration of thumb sensibility with the innervated first dorsal metacarpal artery island flap

Purpose: This study investigated the quality of sensibility from innervated first dorsal metacarpal artery (FDMCA) island flaps in younger and older patients and evaluated the donor site morbidity at the index finger. Methods: Twenty-five patients with an innervated FDMCA island flap to restore sensibility of the thumb were divided into groups according to age (>50 or <50 years). Sensory recovery and cortical reorientation were tested with Semmes-Weinstein monofilaments, a calibrated 2-point discrimination tester, and needle prick testing. Donor site morbidity was evaluated for range of motion, aesthetic appearance, pain, and problems with injuries. Results: The mean age of the patients was 48.3 years and the mean follow-up period was 3 years. The 14 patients older than 50 years had a static 2-point discrimination (s2-PD) of 10.9 mm compared with 10.8 mm of the 11 patients younger than 50 years. The average loss of s2-PD of the flap compared with the donor area averaged 2.7 mm in all patients. Complete cortical reorientation occurred in 7 patients older than 50 years and in 5 patients younger than 50 years. Total loss of range of motion of all donor finger joints was 14° (4.4%) compared with the contralateral index finger. Twenty-two patients were satisfied with the result. Conclusions: There were no age-related differences in the surgical results of the innervated FDMCA island flap and the donor site morbidity was negligible.

Clinical experiences with the extended first dorsal metacarpal artery island flap for thumb reconstruction

A single surgical procedure was created to provide composite resurfacing of total volar or dorsal defects of a thumb with normal length. The procedure involved a flap that included the dorsal skin from both the proximal and middle phalanges of the index finger. The flap included the first dorsal metacarpal artery as well as more than 1 dorsal vein (located at the vicinity of the flap pedicle) and terminal dorsal branches of the radial nerve. Harvesting the dorsal skin of both the proximal and middle phalanges of the index finger is considered a modified version of the first dorsal metacarpal artery flap.

Two new applications for the first dorsal metacarpal artery pedicle in the treatment of severe hand injuries

Two new indications for the use of the first dorsal metacarpal artery (1st DMA) in reconstruction following severe hand injury are reported. In the first case, a primary pollicization of the index finger was based solely on the dorsal arterial network. The second case involves a microvascular arterial revascularisation of a 1st dorsal metacarpal artery island flap. Neither procedure has previously been described.

Second dorsal metacarpal artery neurovascular island flap: clinical applications

This paper reports the clinical use of the second dorsal metacarpal artery island flap in a series of 12 cases and discusses the results. In two cases, a double flap based on the second dorsal metacarpal artery from the dorsal skin of the second and third fingers without using the second web was raised as a modification of the dorsal flap.

The provision of innervated skin cover for the injured thumb using dorsal metacarpal artery island flaps

Provision of stable sensate skin is of great importance in reconstruction of the injured thumb. Island flaps based on the dorsal metacarpal arteries were used to resurface ten injured thumbs, and the degree of retained sensibility was assessed using static and moving two-point discrimination and the pick-up test. Results show that these flaps are capable of providing stable full-thickness skin cover in a single procedure and functional sensibility is retained in most cases. The second dorsal metacarpal artery island flap, previously advocated for use in small thumb defects only, has been successfully used as a large wraparound flap in two cases. In one of these it was used with free bone graft to increase the length of the thumb and an excellent functional result was achieved.

Distally based dorsal metacarpal artery island flap

The use of a distally based third dorsal metacarpal artery island flap to resurface three-fourths of the proximal phalanx of the ring finger is reported.

The second dorsal metacarpal artery neurovascular island flap

The clinical applications of the second dorsal metacarpal artery island flap are illustrated by selective case reports from a series of 12 consecutive cases carried out in this Unit. In five cases the flap was transferred as a neurovascular island flap for sensory resurfacing of the thumb. There were no failures and no donor site complications. The anatomy and clinical dissection of the flap are described.

The first dorsal metacarpal artery neurovascular island flap

A first dorsal metacarpal artery island flap from the index finger was used in 20 cases for reconstruction of defects in the hand. In six cases it was used as a neurovascular flap for sensory resurfacing of the thumb and in five cases for release of a contracted first web. One flap underwent necrosis and there was a complication in one donor site.