Abstract
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.
Keywords finger injuries - perforator flap - hand injuries
