Dorsal Metacarpal Flap Research Articles

Simple syndactyly reconstruction with dorsal metacarpal artery perforator-based propeller flap

Simple syndactyly reconstruction with dorsal metacarpal artery perforator-based propeller flap

Finger reconstruction with dorsal metacarpal artery perforator flaps and dorsal finger perforator flaps based on the dorsal branches of the palmar digital arteries – 40 consecutive cases

Since the first description many variations of the dorsal metacarpal reverse island flap have been published but there is still uncertainty about which vascular component should be included for an optimal result. Therefore, it was the aim of this study to analyze vascular reliability and ischemic complications of dorsal metacarpal artery perforator (DMAP) flaps and dorsal finger perforator (DFP) flaps in our patient collective. We performed 40 of these flaps from the dorsum of hand and fingers for finger injuries. The choice of donor site was made according to the defect’s location. Patients were analyzed with respect to flap necrosis, ischemic complications and achievement of overall reconstruction goals. In addition, we divided our patients in two groups, one group where we raised the flap from the dorsum of the proximal phalanx and a second one where the flaps were raised from the intermetacarpal space to identify complication rates based on the pedicles location. Of the 40 flaps, 36 survived completely. 4 partial necroses were observed in flaps transferred to more distal defects and in one flap that was used in a wrap-around technique for both dorsal and palmar proximal phalanx. These perforator flaps are a reliable method to cover finger defects and the dorsal metacarpal artery is not necessary for their survival, since the blood supply comes from perforating branches of the palmar vascular system. There is a clear trend for a higher complication rate in flaps raised from the dorsum of the fingers compared to the intermetacarpal space.

Application of the first dorsal metacarpal reverse fasciocutaneous flap with the superficial branch of radial nerve for repair of thumb defect

Objective To investigate the clinical efficacy of the first dorsal metacarpal reverse fasciocutaneous flap with the superficial branch of radial nerve for repair of thumb defect. Methods From January 2013 to June 2017, 14 patients with thumb defect were treated using the first dorsal metacarpal reverse fasciocutaneous flap with the superficial branch of radial nerve. The flap area was 2.0 cm×1.5 cm to 4.5 cm×3.5 cm. The donor area was sutured directly in 11 cases and covered with full thickness skin graft in 3 cases. Results All the 14 flaps were survived uneventfully without vascular crisis, necrosis and infection. The patients were follow-up for 6 to 15 months. The appearance of the fingers was aesthetic, the texture was soft, the skin color was close to the surrounding tissue, and the skin flap had good wear resistance. After the operation, the sensation of the flap recovered to S3+ with the two-point discrimination being 6 to 9 mm. The sensation of pain and temperature were recovered. Patients can use their thumbs for daily work and life. Conclusion The first dorsal metacarpal reverse fasciocutaneous flap with the superficial branch of radial nerve has the advantages of reasonable flap design, reliable blood supply, convenient cutting and simple operation. It is an ideal operation for repairing thumb defect. Key words: Surgical flaps; Treatment outcome; Thumb defect; Superficial branch of radial nerve

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

Repairing soft tissue defect of thumb tips in infants by using the first dorsal metacarpal radial artery flaps along with anatomosing of nerves and veins

Objective To investigate the surgical methods and clinical effect of repairing the thumb tip defects in infants by applying the reversed first dorsal metacarpal radial artery island flaps along with anatomosing of nerves and veins. Methods Twenty-one cases with soft tissue defects of thumb tips caused by trauma were admitted from August, 2015 to August, 2017. The first dorsal metacarpal radial island artery flaps were transplanted reversely to repair the defects along with the anatomosis of nerves and veins. Among all the cases, the range of defect area was 2.0 cm×1.8 cm-3.0 cm×2.5 cm. The area range of the flap harvested during the surgery was 2.2 cm×2.0 cm-3.2 cm×2.7 cm. The regular post-operative followed-up was performed. Results All flaps survival after the surgeries, and the wounds were I-staged healing. All cases were followed-up by 3-18 months, and the average time was 7 months. The appearance and quality of the flaps were good. The range of motion of the metacarpophalangeal joints and interphalangeal joints was normal. According to the Upper Extremity Functional Evaluation Tentative Criteria set up by Hand Surgery Branch of Chinese Medical Association, 14 cases were excellent, 5 case was good, and 2 cases were fair. Conclusion The surgery of using the first dorsal metacarpal radial reversed island artery flap to repair the de fect of thumb tip in infant, along with the anatomosis of nerve and vein, is a good method in repairing the defects due to its ease of operation, achievement of plump of finger tip and good recovery of appearance and sensation after the surgery. Key words: First dorsal metacarpal artery; Flap transplant; Finger tips defect; Thumb; Infants

腱付き背側中手動脈皮弁を行った 2 例

腱付き背側中手動脈皮弁を行った 2 例

Reverse dorsal metacarpal flaps for reconstruction of proximal phalanx defects following skin tumor excision: A case series

Background Reverse dorsal metacarpal flaps (RDMFs) are widely used to cover significant skin and soft tissues defects of the finger.However, there is a current lack of information regarding the use of RDMFs in the reconstruction of phalanx defects following skin tumor excision.

Color Doppler ultrasound assessment for identifying perforator arteries of the second dorsal metacarpal flap.

The second dorsal metacarpal (SDMC) perforator flap has been widely used for the soft tissue reconstruction of the hand. However, it is difficult to identify the depth and branches of the perforators of the second dorsal metacarpal artery (SDMA) using only handheld acoustic Doppler flowmetry (HADF), which is the most common method. The purpose of this study was to compare the results of examination by color Doppler ultrasonography (CDU) with those of HADF and to evaluate the efficacy of CDU for detection of the perforators to be used in the design of the SDMC flap. Twenty-two healthy volunteers (42 hands) were examined using both CDU and HADF. All locations identified as the perforators of the SDMA by the two examinations were mapped respectively. The total perforator arteries detected with CDU in all hands were 111 branches, 49 branches of which could not be identified with HADF. The average number of perforators of the SDMA per hand found with CDU was 2.8 branches, while that for HADF was only 1.8 branches. The detection rates of the cutaneous perforators of the SDMA by CDU were 100% in the proximal one-third of the second metacarpal and 95% in the distal one-fourth of the second metacarpal. This study demonstrated the superiority of CDU compared with HADF for detection of the perforators of the SDMA. The CDU examination could easily identify the locations of the cutaneous perforators and help in the useful assessment of vascularity for the SDMC flap.

Clinical application of dorsal metacarpal artery composite flap for coverage of tendon and skin defects of the fingers

Objective To discuss the surgical techniques and treatment outcomes of one-stage repair of complex soft tissue and extensor tendon defect of the fingers by transferring dorsal metacarpal artery flap that includes extensor indicis proprius (extensor digiti minimi proprius) tendon and dorsal cutaneous nerve. Methods From April 2013 to September 2015, 6 cases of middle finger dorsal complex tissue defect were managed with dorsal metacarpal artery composite flap transfer for skin coverage, extensor tendon repair and sensory restoration. The flap size that covered these defects ranged from 6.0 cm×2.0 cm to 7.0 cm×3.0 cm.The donor site was directly closed.Passive functional exercise was initiate done one week postoperatively and lasted for 4 to 6 weeks. Results All 6 flaps survived completely. All the patients were follow-up for 3 to 13 months with an average of 8.2 months. Sensation of the flaps recovered to S3 level. Two-point discrimination was 7 to 10 mm while the mean value was 8.6 mm. The color, texture and contour of the flaps were good. Mobility of the hand was satisfactory. Conclusion Dorsal metacarpal artery composite flap transfer is a reliable way to cover complex tissue defects on the dorsum of fingers. It has consistent vascular anatomy, affords extensor tendon and cutaneous nerve reconstruction along with skin coverage, shortens treatment time, and improves outcomes without added risks. Key words: Surgical flaps; Finger injuries; Metacarpal artery; Compound tissue flap

The application of the dorsal metacarpal perforator sliding flap for web-space reconstruction in congenital syndactyly

To investigate the application of the dorsal metacarpal perforator sliding flap for web-space reconstruction in congenital syndactyly. According to the size and shape of skin defect at the web space after division operation of syndactyly, the corresponding intermetacarpal perforator sliding flap was designed. The edge of the flap was cut off, but its underlying tissue was not dissected. From May 2007 to November 2012, 28 web-spaces in 15 patients with syndactyly (10 male and 5 female) were reconstructed. All the 28 flaps survived completely. The flap size ranged from 3 cm x 2 cm to 1.5 cm x 1.0 cm. 14 cases with 26 flaps were followed up for 10-22 months (average, 14.5 month). The reconstructed web spaces had normal appearance and movement range. The 2-point discrimination distance was 9-13 mm (average, 11 mm). According to the Swanson Standard, 18 fingers were graded as excellent, 8 as good and 2 as fair (excellent and good, 92.6%, 26/28). Reconstruction of web-space in syndactyly with the dorsal metacarpal perforator flap has the advantages of easy handling, good cosmetic and functional results.

Different distal-based dorsal metacarpal flaps for repair of soft tissue defects of the finger

Objective To explore the application of dorsal metacarpal flaps based on different distal pedicles for repair of soft tissue defects of the fingers. Methods From June 2008 to May 2009,soft tissue defects of 45 fingers in 37 patients were repaired by distally-based retrograde dorsal metacarpal flaps.Among these dorsal metacarpal flaps,29 were pedicled on the finger web perforator,and 16 were pedicled on the dorsal perforator of the digital artery. Results Forty-one flaps survived uneventfully.Minor blood circulation compromise was noted in 4 flaps.The situation was salvaged by removing a couple of stitches at the distal portion of the flaps.These flaps survived and healed as well.Postoperative follow-up was sufficient in 37 cases,ranging from 10 to 24 months.All repaired fingers had satisfactory appearance and good function.The outcomes were graded as excellent in 30 cases,good in 5 cases,fair in 2 cases,and the good and excellent rate of finger function reached 94.6％ according to the provisional functional assessment criterion for upper limbs issued by the Hand Society of Chinese Medical Association. Conclusion The blood circulation of dorsal metacarpal flap is commonly supplied by dorsal metacarpal artery perforators and dorsal metacarpal cutaneous nerve nutrient vessels,which anastomose widely around the metacarpophalangeal joint and the proximal phalanx.This provides the options of different distal pedicles which can be selected for flap design to effectively meet the needs of wound coverage of the fingers. Key words: Island flaps; Finger injuries; Surgical procedures,operative

First Dorsal Metacarpal Artery Adiposofascial Flap for Venous Conduit and Soft Tissue Cover in an Avulsed Thumb: Case Report

Skin loss, need for vein grafts, and secondary surgeries are often encountered in avulsion injuries of the thumb. We report a case of successful salvage of an avulsion type of near total amputation of the thumb following a conveyor belt injury in which the first dorsal metacarpal artery adiposofascial flap was used for combined soft tissue cover and venous conduit.

Color Doppler Ultrasound Assessment to Identify the Perforator Artery of the Second Dorsal Metacarpal Flap

Color Doppler Ultrasound Assessment to Identify the Perforator Artery of the Second Dorsal Metacarpal Flap

Cutaneous branches of second and third dorsal metacarpal artery fasciocutaneous flaps for repair of distal- and middle-segment finger soft tissue defects

Objective To evaluate the clinical efficacy of cutaneous branches of reverse second and third dorsal metacarpal artery fasciocutaneous flaps for repair of distal- and middle-segment finger soft tissue defects. Methods A total of 14 patients with distal- and middle-segment finger soft tissue defects complicated by exposure of the phalanx or tendon were repaired by using cutaneous branches of second and third dorsal metacarpal artery fasciocutaneous flaps ranging between 2.0 cm × 4.5 cm and 3.0 cm × 7.0 cm.Resuits All of the skin flaps survived after surgery.Follow-up data during a 6-40 month period showed that the flaps exhibited a satisfactory appearance.They were not fat or clumsy,with a 2-point discrimination of 59 mm,and there was good recovery of finger function.The donor site was able to be directly sutured without dermoplasty.Pigmented linear surgical streaks appeared in the donor site. Conclusion The cutaneous branches of Second and third dorsal metacarpal artery fasciocutaneous flaps provide a good approach for the repair of distal- and middle-segment finger soft tissue defects and functional reconstruction because of convenient dissection,little trauma,sufficient use of the dorsal metacarpal artery. Key words: Finger; Dorsal metacarpal artery; Fasciocutaueous flap; Microsurgical operation

Web reconstruction with dorsal metacarpal rhombus advancement flap in the treatment of syndactyly

Objective To report the clinical outcomes of reconstructing the web with dorsal metacarpal rhombus advancement flap in the treatment of syndactyly. Methods Five children with syndactyly were operated. After the digits were divided, a dorsal rhombus flap was designed between the metacarpal heads and advanced to reconstruct the web space. The following aspects were evaluated during postoperaive follow-up:finger function, web space and appearance, and patients' satisfaction. Results The area of flaps ranged from 1.5 cm× 0.6 cm to 2.0 cm× 0.9 cm. All the flaps healed primarily without flap congestion and marginal necrosis. The patients were follow-up for 6 to 12 months with an average of 8.5 months. Finger flexion and extension was good. The contour of the web was satisfactory with appropriate width and depth. The patients' parents were satisfied with both finger function and web appearance. Conclusion Dorsal metacarpal rhombus advancement flap is a reliable flap with easy dissection and good texture for web reconstruction in syndactyly surgery. Key words: Hand deformities,congenital; Syndactyly; Surgical flaps

El Parmak Defektlerinin Onarımında Güvenilir ve Kullanışlı Bir Flep:Ters Akımlı Dorsal Metakarpal Arter Pediküllü Flep

Reverse flow dorsal metacarpal artery pediculled flap is one of the easily apllicable and useful flap alternatives which are used for closing the defects of the hand fingers. The aim of this study is evaluate complications and outcomes of finger defects repairing with reverse flow dorsal metacarpal artery pediculled flap. From 1999 till 2009 we applied this technique for repairing fingers’ defects in totally of 15 patients. 5 of them represent after electric burn injury, 4 after endustrial trauma, 4 after excision of squamous cell carsinoma ( SCC ) and 2 after contracture opening procedure. Nine of them were male and 6 female with mean age of 39. Most of used arteries were 2nd or 3rd dorsal metacarpal. Follow ups for these patients lasted around 30 month (11 - 45 month). In 2 patients flaps were lost due to inappropriate pedicle rotation and after the debridement of the flaps, the defects were repaired with “cross-finger” flaps. Reverse flow dorsal metacarpal flap which does not damage the major arterial system of the hand and is easily applicable and useful technique, has good skin color and tissue compatibility, and can be used for fingers’ defects repairing.

Cause investigation and management of necrosis in reversed island flap or distally-pedicled flap

Objective To propose the cause and management of necrosis in reversed island flap or distally-pedicled flap. Methods From June 2000 to June 2009, 120 cases with skin and soft tissue defect were repaired using reversed island flap or distally-pedicled flap. In 12 cases the flaps partial necrosis, to analysis the cause of necrosis. Results One hundred and eight cases survived completely in 120 patients,flap necrosis in 12 cases. 3 cases fully necrosis, in which venous disorders cause flap necrosis in 2 cases, arterial blood disorder caused necrosis of flap in 1 case. Partial necrosis in 9 cases, in which dorsal metacarpal artery reversed island flap in 1 case, digital artery reversed island flap in 1 case, posterior tibial artery reversed island flap ankle epithelial branch in 4 cases, medial leg perforating branches of reversed island flap in 1 case, superficial peroneal nerve vascular reversed island flap island flap in 1 case, distally-pedicled based sural neurocutaneous flap in 1 case, after debridement and dressing change subeschar healed in 7 cases, by the other flaps were cut close to rerepair necrotic wounds in 2 cases. Conclusion Blood circulation barrier is the main reason to flap necrosis, improper handling of pedicle is another important reason of flap necrosis,which cannot be ignored. Key words: Surgical flaps; Island flaps; Transplantation; Necrosis; Microsurgery

The Modified V-Y Dorsal Metacarpal Flap for Repair of Syndactyly without Skin Graft

Syndactyly repairs that use full-thickness skin grafts risk graft-related complications. The dorsal V-Y advancement flap offers a method of syndactyly release that can eliminate the need for full-thickness skin grafts in some cases of simple syndactyly. A retrospective case series of all patients undergoing syndactyly release without skin grafting performed by the senior author (B.C.) between 1998 and 2007 was conducted. All outpatient and inpatient charts were reviewed for pertinent patient demographics and clinical outcomes, including the incidence of web creep, hypertrophic scarring, flexion contracture, infection, angulation deformity, limited range of motion, ischemia, and need for reoperation. A total of 28 syndactylies were included in the study: 25 simple incomplete and three simple complete. Mean follow-up time was 4.2 years. Mean operative time was 68 minutes. Two patients (7.1 percent) experienced postoperative complications; both were corrected by subsequent revision. The dorsal V-Y advancement flap without skin graft is an effective method of repair primarily in simple incomplete syndactyly.

Thumb reconstruction by grafting skeletonized amputated phalanges and soft tissue cover – A new technique: A case series

This study reports five cases of crush-avulsion injury to the thumb at different levels presented at our plastic and hand surgery unit between 2005 and 2007. All of the patients were male labors with machine injuries to the thumb with non-replantable amputations. Distal phalanx or proximal phalanx, or both, were used as a free cortical bone graft. The amputated part was skeletonized keeping the periosteum attached to the cortical bone of the phalanx fixing it to the stump and covering it by either local flap like dorsal metacarpal flap or regional flaps like the distally based pedicled radial forearm flap and neurovascular island sensate flap or groin flap. The results were functionally and cosmetically good and follow up X rays showed no osteoporotic resorption after one year.

15: Clinical Application of Reverse Dorsal Digital and Metacarpal Flaps

15: Clinical Application of Reverse Dorsal Digital and Metacarpal Flaps