First Dorsal Metacarpal Artery Research Articles

Neurotized first dorsal metacarpal artery flap for reconstruction of thumb defects: does it helps to improve sensory outcomes?

Restoration of tactile sensation after reconstruction of a thumb pulp defect is important for hand function. We have evaluated the functional, sensory and aesthetic outcomes of neurotized first dorsal metacarpal artery (FDMA) flap in reconstruction of various soft tissue defects of the thumb. For a period of 18 months (January 2021 to June 2022), a total of 20 patients were considered for the study and divided into two groups that is neurotized (group A) and conventional (group B) FDMA flaps. One flap in each group underwent complete necrosis. Results were compared with patients treated by the conventional Foucher’s FDMA flap without nerve repair. At the final follow-up, flap sensation was assessed using static two-point discrimination and Semmes–Weinstein monofilament (SWM) testing. The mean values for active range of motion, total time for procedure, average time to return to routine work and time period of cortical reorientation were statistically significantly different from the values in the control group (p value <0.05). 2-PD, SWM and cold severity score were found to be statistically non-significant. Neurotized FDMA island flap provides a stable, sensate and reliable option for sensory reconstruction of thumb pulp defects with earlier cortical reorientation that allows easier physical rehabilitation and earlier ability to return to previous work to the patients.

Reconstruction of soft tissue defects of hand: A systematic approach.

A thorough insight into the management of hand injuries can shape the approach of a surgeon in order to achieve optimal outcomes for the patients. The aim of this study was to share our experience in reconstruction of the hand and establishing an algorithm for classification and treatment of hand injuries. This is a descriptive cross sectional study and was conducted from January 2020 to August 2022 at Burns and Plastic Surgery center, Peshawar. Data was collected from medical records about the patient demographics, mechanism of injury and type of procedures done. Defect size was classified into small (<5cm), medium (5cm to 10 cm) and large (>10cm). The defect site and size was cross tabulated against the method of soft tissue reconstruction in order to make the algorithm for reconstruction of hand injuries. Data was analyzed using SPSS. The study population included 41 (75.9%) male and 13 (24.1%) female patients, mean age 31.56±14.1. Machine injuries (33.3%) and electric burns (24.1%) were the most common cause of hand soft tissue defects. The most commonly performed flap was Posterior introsseous artery (PIA) flap, followed by First dorsal metacarpal artery (FDMA) flap. Flap necrosis was observed in three cases (5.6%). This treatment algorithm for coverage of soft tissue defects in hand injuries will help with the decision making process of hand reconstruction and has didactic value for novice surgeons. It will also form the foundation for further work on this aspect of hand injuries.

First dorsal metacarpal artery flap in soft tissue reconstruction of recurrent thumb squamous cell carcinoma

Background. Subungual squamous cell carcinoma (SCC) of thumb is a rare disease. However, it is the most common malignancy affecting the nail bed. Early recognition is crucial and important for prompt diagnosis and effective treatment. Often this tumour needs to be treated surgically with wide local resection, which results in a defect in the thumb. If not handled appropriately, such defects render restriction in functionality of the involved thumb as well as a poor aesthetic outcome. In the worst-case scenario, it may result in a poor function of involved hand. Thus, reconstruction of the involved thumb is necessary. The main aim of reconstruction is to regain the hands' function and preserved the thumbs' sensation. Secondarily, to have an aesthetically pleasing hand. Our hands carry out delegate job and important duty for daily function. Especially, the thumb working together with the other fingers to carry out the hand function as one unit. Loss of thumb function affects the whole performance of the hand. Case descriptions. We report a case of recurrent subungual squamous cell carcinoma of thumb, which had wide local resection and subsequently underwent soft tissue coverage with an islanded first dorsal metacarpal artery (FDMA) perforator flap. One month after surgery, the patient was able to regain a good functional outcome of the hand. In this report, we discussed the procedures that had been done. Conclusion. The patient regained full functional hand after reconstruction with preserved sensation over distal thumb. The aesthetic outcome is satisfactory. The FDMA perforator flap is a very pliable and robust flap for reconstruction of distal thumb defect.

Chicken Feet: A Model for Practising Locoregional Flaps of the Hand.

Background: The aim of this study was to determine the feasibility of the chicken foot model for surgical trainees interested in practising the designing, harvesting and inset of locoregional flaps of the hand. Methods: A descriptive study was performed to demonstrate the technical aspects of harvesting four locoregional flaps in a chicken foot model: fingertip volar V-Y advancement flap, four-flap and five-flap Z-plasty, cross-finger flap and first dorsal metacarpal artery (FDMA) flap. The study was performed in a surgical training laboratory on non-live chicken feet. No participants were involved in this study, apart from authors performing the descriptive techniques. Results: All flaps were successfully performed. Anatomical landmarks, soft tissue texture and flap harvest, as well as inset closely resembled clinical experience with patients. Maximal flap sizes were 12 × 9 mm for volar V-Y advancement, 5 mm limbs for Z-plasties, 22 × 15 mm for cross-finger flaps and 22 × 12 mm for FDMA flaps. The maximal webspace deepening with four-flap/five-flap Z-plasty was 20 mm and the FDMA pedicle length and diameter was 25 and 1 mm, respectively. Conclusions: Chicken feet can be effectively used as simulation models for hand surgical training with respect to gaining familiarity with the use of locoregional flaps of the hand. Further research requires testing for reliability and validity of the model on junior trainees.

First Dorsal Metacarpal Artery Flap : A Reliable Option for Reconstruction of Extensive Pulp Defects of the Thumb

Background: Thumb pulp defects are commonly due to avulsion injuries. The choice of reconstructive procedure for thumb depends on the amount and type of tissue lost. The First Dorsal Metacarpal Artery (FDMA) flap is a versatile method with minimum donor site morbidity which provides protective sensation, adequate length, stability and good mobility. Method: This study was done over a period of 2 years and involved 15 consecutive cases of thumb pulp defects treated at our institution. The patient included 13 men and 2 women ranging in age from 16 to 60 years. The defects were ranged from 2cm x 1.5cm to 5cm x 3cm. Results: All flaps survived completely except one had marginal flap necrosis healed without the need for a secondary procedure. Donor site was covered with full thickness skin graft that healed spontaneously. Conclusion: First dorsal metacarpal artery flap offers a sensate, pliable and versatile coverage for soft tissue defects of the thumb. It provides good functional Results with minimum donor site morbidity. J Bangladesh Coll Phys Surg 2023; 41: 53-57

Utility of First Dorsal Metacarpal Artery Flap for Thumb Defects.

Background Reconstruction of thumb tip, while providing a durable and sensate flap, is a challenging task. It is important as thumb accounts for 50% of hand functions. Options for coverage are: healing by secondary intention, local/regional flaps, microsurgical toe wraparound flap, etc. First dorsal metacarpal artery (FDMA) flap is one regional flap that has been used for thumb cover, usually for defects till interphalangeal joint or just distal to it. We present our case series for FDMA flap and its variations for thumb reconstruction. We also report reverse FDMA flap cover for reconstruction of defects over distal phalanx of thumb. Methods The procedure was performed in patients with partial loss of thumb soft tissue in 16 patients presenting during 2017 to 2020. The FDMA flap was performed according to the standard technique. In case after "planning in reverse," it was seen that the reach of FDMA flap was insufficient, reverse FDMA flap was done. Physiotherapy for index finger and thumb was started on day 10. Patient satisfaction, in terms of cosmesis and function was recorded (graded as poor, good, and very good). Static two-point discrimination (2-PD) was assessed at 6 months' follow-up. Patients were followed up for 6 months. Results The operative time was 1 to 2 hours. Out of total 16 cases, 8 patients underwent racquet-shaped (intact skin paddle) FDMA flap. Islanded flap was performed in five and reverse FDMA flap in three. Twelve patients had uneventful recovery and four patients (three islanded and one reverse FDMA) had partial skin loss. Static 2-PD was assessed at the 6 months postoperative period. Conclusion FDMA flap is a useful regional flap for thumb reconstruction. It provides good supple, durable, and sensate cover. The reverse FDMA flap that increases the pedicle length can be used for more distal defects, where conventional FDMA flap is doubtful.

The Oblique Extended Reverse First Dorsal Metacarpal Artery Perforator Flap for Coverage of the Radial-Volar Defect of the Proximal Interphalangeal Joint in the Index Finger: A Case Report.

The dorsal metacarpal artery perforator flap is a flap that rises from the hand dorsum. Owing to its reliability and versatility, this flap is used as a workhorse for finger defect. However, to cover the radial-volar defect of the proximal interphalangeal joint (PIPJ) of the index finger, a longer flap is required than before. Here, we introduce the oblique extended reverse first dorsal metacarpal artery (FDMA) perforator flap to cover the radial-volar aspect defect of the index finger. A 45-year-old man got injured to the radial-volar defect of PIPJ of the left index finger caused by thermal press machine. The wound was 2 × 1 cm in size, and the joint and bone were exposed. We used FDMA perforator from anastomosis with palmar metacarpal artery at metacarpal neck. Since the defect was extended to the volar side, the flap was elevated by oblique extension to the fourth metacarpal base level. The fascia was included to the flap, and the flap was rotated counterclockwise. Finally, PIPJ was fully covered by the flap. Donor site was primarily closed. After 12 months of operation, the flap was stable without complication and limitation of range of motion. The oblique extended reverse FDMA perforator flap is a reliable method for covering the radial-volar defect of the PIPJ of the index finger. This flap, which also has an aesthetic advantage, will be a good choice for hand surgeons who want to cover the PIPJ defect of the index finger using a nonmicrosurgical option.

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

Mid-Term Results of the First Dorsal Metacarpal Artery Flap for Thumb Defects.

Background: The thumb plays an important role in the function of the hand. Sensate reconstruction of the pulp is important in restoring function to the thumb. The aim of this study is to present outcomes of a sensate islanded first dorsal metacarpal artery (FDMA) flap used for the reconstruction of skin defects of the thumb. Methods: Patients who had a FDMA flap reconstruction of thumb pulp defects in the orthopaedics and traumatology clinic of affiliated hospital were included in the study. This included eight thumbs of eight patients. The range of motion, sensation and cosmetic satisfaction in the donor and recipient areas were evaluated at a minimum of 2-year follow-up. Results: There were no partial or complete flap failures. The mean static 2-point discrimination was 15 mm and the mean Semmes-Weinstein monofilament test score was 3.93. Cortical re-orientation was observed in 65% of patients. Near normal range of motion and Kapandji scores were regained in all patients. Conclusions: Excellent motion and sensory outcomes were obtained following the FDMA flap reconstruction of thumb pulp defects. The donor morbidity of the flap is minimal, and this flap can be considered as one of the primary options for reconstruction of thumb pulp defects. Level of Evidence: Level V (Therapeutic).

A Comparison of Outcomes of Reconstruction of Palmar versus Dorsal Defects of the Thumb Using a First Dorsal Metacarpal Artery Flap with a Cutaneous Bridge Segment.

Background: The aim of this study is to compare outcomes of reconstruction of palmar versus dorsal defects of the thumb using the first dorsal metacarpal artery (FDMA) flap with a cutaneous bridge segment. Methods: All FDMA flaps done at our centre for reconstruction of traumatic thumb defects in the period from November 2017 to May 2019 were included in this study. Data with regard to the patient, the injury and the flap were recorded. The outcome measures recorded include flap survival, complications, duration of follow-up, static two-point discrimination (2-PD), cortical reorientation, paresthesia at the flap and donor site, pain at the flap and donor site, Kapandji score and aesthetic outcome. Results: The study included 11 patients with an average age of 35 years. All patients were men, and the injury involved the dominant thumb in seven patients. There were five dorsal defects and six palmar defects, and the average defect size was 7.22 sq cm. All flaps survived and there were no complications. The mean follow-up period was 15.2 months. The mean static 2-PD was 9.35 mm, cortical reorientation was complete in six patients, paresthesia score at the flap was 0.27 and at the donor site was 0.36. The visual analogue scale (VAS) pain for the flap was 1.09 and for the donor site was 1.27. The average Kapandji score was 8.64 and patients rated the aesthetic outcome of the flap at 8 and of the donor site at 7.36. There were no differences in outcomes between palmar and dorsal defects except for the aesthetic outcome of the flap that was rated better for dorsal defects. Conclusion: The FDMA flap designed with a cutaneous bridge segment provided reliable, single-stage reconstruction of dorsal and palmar thumb defects with good outcomes. Patients rated the aesthetic outcome of flaps used for dorsal reconstruction higher. Level of evidence: Level IV (Therapeutic).

The use of the dorsal metacarpal artery for reconstruction of distal dorsal finger defects: an anatomic study and clinical experience

Purpose: Dorsal metacarpal artery (DMA) flaps have been used successfully for distal dorsal finger defects. Some studies have reported inconsistent DMA anatomy, and there have been no studies on the anatomic variation of DMAs in Asian cadavers. Therefore, we evaluated the anatomy of DMA using Korean fresh cadavers and reported the clinical outcomes of the DMA flaps.Methods: In the cadaver study, four human forearms from adult fresh cadavers were dissected. The dorsal metacarpal arteries and their communicating branches were identified. From July 2016 to June 2019, five patients with dorsal finger defects underwent a first DMA (FDMA) flap or a reversed DMA (RDMA) flap.Results: In our cadaver study, the ulnar branch of the FDMA and the second and third DMAs were absent in two of four (50%) of the cadavers. In our case series, five flaps survived, and one had partial necrosis, which healed by the second intention. The mean operation time was approximately 100 minutes, and the mean outpatient follow-up period was 6 months.Conclusion: DMA flaps are a reliable flap for the reconstruction of relatively large soft tissue defects of the dorsal finger. However, in our anatomical study, inconsistency of the anatomy of DMAs was identified. Therefore, preoperative Doppler examination is required to evaluate the anatomy of the DMA before considering the use of DMA flaps.

First dorsal metacarpal artery perforator-based propeller flap: functional anatomy and clinical application in soft-tissue defects of the dorsal hand and digits.

Many approaches have been reported to repair soft-tissue defects of the hand using dorsal metacarpal artery flaps. Use of a perforator-based propeller flap from the first intermetacarpal space to the dorsum of the hand has been described. The aim of this study was to confirm the functional anatomy of a first dorsal metacarpal artery (FDMA) perforator flap. Twenty-nine fixed cadaveric hands were dissected to determine the origin, course, and branches of the FDMA. Clinically, five cases of soft tissue defects of the hand underwent reconstructive surgery using an FDMA perforator-based propeller flap. The FDMA was found in 27 specimens (93%). The ulnar branch of the FDMA always supplied the cutaneous perforator (mean ± SD, 4.3 ± 1.6), and the most distal cutaneous perforating branch was found along the metacarpal long axis within 25mm of the tip of the metacarpal head with high frequency (28/29, 97%). In the two hands that had aplasia of the FDMA, well-developed perforators arose directly from the radial artery and advanced to the metacarpal head. Seven hands (24%) had perforators arising from the palmar arterial system, penetrating through or passing close by the second metacarpal bone. In clinical application, all the flaps survived completely without major complications. The FDMA perforator-based propeller flap is minimally invasive and technically simple. It is expected to be a new option for hand reconstruction.

A Modification to Enhance the Survival of the Island FDMA Flap by Adding a Skin Bridge.

Background:Distal thumb injuries are common in high construction load regions, and it is a challenging task for the plastic surgeon to find the optimum choice that preserves thumb length and provides a sensory substitute to the lost tissue. Introducing first dorsal metacarpal artery flap has solved the dilemma. One drawback is that the flap is susceptible to distal necrosis, which can happen because of tight tunneling or insufficient venous drainage. We combined Foucher and Holevich characteristics to design a flap that promises to solve the problem.Methods:This is a case series that includes 9 patients where we describe a technique that has the potential to enhance the survival of the first dorsal metacarpal artery (FDMA) flap and decreases the rate of distal necrosis via addition of a 5-mm skin bridge to the pedicle and by avoiding tunneling. Distal necrosis of the patients in this study patients was compared with that in a control of 10 patients in whom we did the conventional FDMA flap. Patients were followed for 6 weeks to trace early postoperative complications (infection, dehiscence, and necrosis) and the establishment of protective sensation (pain and temperature).Results:None of our patients had distal necrosis, infection, or dehiscence, and all had protective sensation in the flap. In comparison, 4 patients in the control group developed distal necrosis.Conclusion:FDMA is one of the best choices when it comes to distal thumb reconstruction, but it has the disadvantage of distal necrosis, which might be avoided when using the technique mentioned in this study.

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.

First dorsal metacarpal artery flap a workhorse for reconstruction of selected small defects of the hand

Background: The first dorsal metacarpal artery (FDMA) flap is used mainly for reconstruction of thumb defects. We share our experience of this flap for various defects of thumb and also its use to cover other defects. Materials and Methods: Case records of 15 patients with FDMA flap between October 2015 and February 2018 at our center were analyzed retrospectively. Data were analyzed for etiology, associated comorbidities, interval between injury and operation, site of defect, harvesting technique, and inclusion of dorsal interossei muscle cuff, complications, donor-site morbidities, and postoperative sensory recovery. Results: Of 15 patients, 13 were male and 2 were female. Eleven patients had a posttraumatic defect, 2 had post-electric burn defect, 1 had a firecracker injury, and 1 had a post snakebite defect. Of 15 patients, 12 patients had thumb defects, 1 patient with defect of first web space, 1 on volar aspect of palm, and 1 on the dorsum of hand over the head of third metacarpal. All patients showed protective sensations and 6 patients with 12-month follow-up showed minimum of 9 mm of two-point discrimination with no donor-site morbidity. Conclusions: The FDMA flap has a constant anatomy, easy dissection, and shows good functional and esthetic results. FDMA flap is the first treatment of choice for defects of the thumb, but it can be used for selected small defects of hand due to its wide arc of rotation.

The first dorsal metacarpal artery flap: A practical operation for thumb reconstruction

Objective: To present six cases treated with kite flap for thumb reconstruction and to discuss important aspects of the first dorsal metacarpal artery (FDMA) flap technique along with the pertinent literature. Method: We evaluated the age, etiology, operation time, and postoperative flap necrosis of six patients who had undergone thumb reconstruction with FDMA flap between 2014 and 2017. All patients signed a written informed consent form. A) Relevant anatomy: The FDMA is a branch of the radial artery. It supplies the dorsal aspect of the index finger up to the proximal interphalangeal (PIP) joint. The artery is located in the groove between radial of the body of the second metacarpal bone and the ulnar head of the first interosseous muscle. B) Flap design and surgical technique: The proximal and distal borders of the flap were constituted from the metacarpophalangeal (MCP) and PIP joints, respectively. Flap elevation was performed from the distal to proximal direction and from the ulnar to radial side. Results: The average patient age was 46.8 years. Five patients underwent surgery due to trauma and one patient underwent surgery due to a painful scar on the tip of the thumb. For the five trauma patients, thea verage operation time was 1.4 days. The patient with the painful scar had sustained the trauma 15 years ago. Flap necrosis was not observed. The average postoperative follow-up duration was 1.6 years. Conclusion: The FDMA flap is a safe and practical solution for thumb reconstruction provided that the anatomy of the FDMA is well known and proper technique is used.

Ulnar Thumb Pulp Reconstruction Using the Anterograde Homodigital Neurovascular Island Flap.

The thumb ulnar pulp is a critical component of key pinch and precision manipulation. Injuries to this area should be reconstructed with robust, sensate tissue that restores bulk and contour. The existing reconstructive options, however, have substantial risks and drawbacks. We describe an anterograde homodigital neurovascular island flap that provides both sensate and durable coverage of the ulnar thumb pulp. The flap uses innervated glabrous tissue, limits donor site morbidity to the thumb and first web space, and does not require microvascular anastomoses or nerve coaptation. The flap has been previously described for nonthumb fingertip injuries, but it has not been applied to the thumb. We discuss several important technical modifications that are essential to raising and insetting this flap in the thumb, review potential pitfalls, and highlight key steps to ensuring judicious intraoperative decision making and success.

Unusual pattern of the first dorsal metacarpal artery

This report describes an unusual pattern of the first dorsal metacarpal artery (FDMA) regarding its course and termination. This FDMA had an abnormal course, passing deep to various anatomical elements related to the index finger, with unusual termination in the radial and ulnar proper palmar digital arteries feeding the second and third fingers, respectively. There is no mention of this anatomical variation in the literature. We report the possible embryological origin of this case and other variations related to the FDMA. This unusual pattern represents a new reason to consider anatomical knowledge important for surgeons whose procedures are in this area and to ensure an accurate diagnosis and safe treatment of pathologies that might engage this anatomical variation.

Thumb Reconstruction Using Foucher's Flap.

BACKGROUND:Extensive pulp 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.AIM:This paper is focused in Foucher’s neuro vascular flap. First DMCA or Foucher’s pedicle flap is a successful thumb reconstruction method, especially in patients not disturbed by its cosmetic appearance.MATERIAL AND METHODS:The first dorsal metacarpal artery (FDMCA) arises from the radial artery in the first intermetacarpal space, just distal to the tendon of the extensor pollicis longus. Pulp area of the thumb is the area where Foucher’s flap is more utilizable. This technique has other applications such as first web reconstruction, thumb lengthening, and following resection of tumors on the dorsum of the hand.RESULTS:We have in study 7 cases with work related trauma in two years period of time, between 2012 and 2014. We had only one partial flap survival and all the other flaps survived entirely. We have also taken in consideration subjective satisfaction with a range score from 4 to 10, cold intolerance, flap area and donor site sensibility with a range score from low to medium to normal.CONCLUSION:Careful pedicle discovery, secured elevation, pedicle strangulation prevention are very important for flap survival.

Treatment of thumb soft-tissue defects using a bipedicle island flap of the index finger: anatomical basis and clinical application

Reconstruction of the thumb with exposure of bone and tendon is challenging. We designed a bipedicle island flap from the dorsum of the index finger to repair thumb defects. One pedicle includes the radial proper palmar digital artery (PDA) of the index finger, another pedicle includes the first dorsal metacarpal artery (FDMA). The aim of the study was to investigate the anatomical basis and clinical application of this flap. Eleven fresh cadaver hands were dissected, the FDMA and the radial proper PDA were exposed. Their origin, distribution and diameter in different locations, especially in the dorsum of the proximal phalanx of the index finger, were examined. Ten patients (11 hands) underwent thumb reconstruction using this flap. During follow-up, the flap survival and hand function were evaluated. The origin of the FDMA in three cadaver hands was abnormal. The FDMA was mainly distributed in the proximal area of the dorsum of the proximal phalanx. The radial proper PDA of the index finger formed one constant dorsal branch, mainly distributing in the middle and distal area of the dorsum of the proximal phalanx. All flaps survived. At follow-up, the span of the first web and the range of motion of the thumbs and index fingers reached more than 94% of the contralateral finger. All patients were satisfied with the hand function according to the Michigan Hand Outcomes Questionnaire (MHQ). The bipedicle island flap has two arterial systems to provide sufficient blood supply. This technique provides another option for thumb reconstruction when a large supercharged FDMA island flap needs to be designed, or when there is an additional injury to the radial side of the dorsum of the hand or if there are anatomical variations of the FDMA, or if damage to the FDMA occurs during surgery.