Subscribe to RSS
DOI: 10.1055/s-0042-1750691
First Dorsal Metatarsal Artery Free Flap for Finger Coverage Defect: A Case Report
Article in several languages: español | English
Abstract
Severe finger injuries with loss of substance and exposure of noble structures are a challenge to avoid amputation. These situations have prompted the development of many local axial flaps to save the digit. Customized free flaps have also been described to provide adequate and good-quality coverage. We present the case of a patient with a severe injury to the ring finger with bone exposure and tendinous damage, with a coverage defect of 4 × 4 cm. The patient underwent reconstruction with a free flap from the foot, taking the first intermetatarsal artery as the donor vascular axis. The patient kept his finger with mobility at the expense of the proximal interphalangeal (PIP) joint, with good-quality skin, firm clamp, and no pain. The donor area did not present complications. In the hands of a trained team, with adequate indication, these flaps achieve a good esthetic and functional result.
Level of Evidence 3.
Keywords
coverage defect - free flap - metatarsal artery - upper extremity reconstruction - microsurgeryPublication History
Received: 21 December 2020
Accepted: 17 May 2022
Article published online:
03 October 2022
© 2022. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
Referencias
- 1 Midgley RD, Entin MA. Management of mutilating injuries of the hand. Clin Plast Surg 1976; 3 (01) 99-109
- 2 Miller EA, Friedrich J. Soft Tissue Coverage of the Hand and Upper Extremity: The Reconstructive Elevator. J Hand Surg Am 2016; 41 (07) 782-792
- 3 Méndez M. Colgajos dorsales axiales de la mano. Rev Chilena Ortop Traum 2004; 1 (45) 40-45
- 4 Balan JR, Mathew S, Kumar P. et al. The reverse dorsal metacarpal artery flap in finger reconstruction: A reliable choice. Indian J Plast Surg 2018; 51 (01) 54-59
- 5 Gottlieb, Lawrene J. M.D.; Krieger, Lloyd M. M.B.A., M.S.I.V. From the Reconstructive Ladder to the Reconstructive Elevator. Plastic and Reconstructive Surgery 1994; 93 (07) 1503
- 6 Terzis JK, Kostopoulos VK. Vascularized nerve grafts and vascularized fascia for upper extremity nerve reconstruction. Hand (N Y) 2010; 5 (01) 19-30
- 7 Koshima I, Harii K. Experimental study of vascularized nerve grafts: multifactorial analyses of axonal regeneration of nerves transplanted into an acute burn wound. J Hand Surg Am 1985; 10 (01) 64-72
- 8 May Jr JW, Chait LA, Cohen BE, O'Brien BMCC. Free neurovascular flap from the first web of the foot in hand reconstruction. J Hand Surg Am 1977; 2 (05) 387-393
- 9 Gilbert A. (1976) Composite tissue transfers from the foot: Anatomic basis and surgical technique. In: Daniller A, Strauch B. eds. Symposium on Microsurgery. St Louis, Mo: Mosby; 1976
- 10 Hou Z, Zou J, Wang Z, Zhong S. Anatomical classification of the first dorsal metatarsal artery and its clinical application. Plast Reconstr Surg 2013; 132 (06) 1028e-1039e
- 11 Méndez M, Bifani A, Andrade F. Reconstrucción de Pulgar con Técnica de Wrap- Around. Rev Chilena Ortop Traum 2005; 2 (46) 94-100
- 12 Rose EH, Kowalski TA. Restoration of sensibility to anesthetic scarred digits with free vascularized nerve grafts from the dorsum of the foot. J Hand Surg Am 1985; 10 (04) 514-521
- 13 Wang L, Xie QP, Wang HJ. Free first dorsal metatarsal artery perforator flap for multiple finger defects reconstruction: a case report. J Hand Surg Eur Vol 2018; 43 (06) 666-668