The reverse dorsal metacarpal artery flap in finger reconstruction: A reliable choice

Jyoshid R. Balan; Shaji Mathew; Pradeep Kumar; Harsh Vardhan; Anto Francis; V. G. Aniljith; Raj Gopal

doi:10.4103/ijps.IJPS_37_17

Indian Journal of Plastic Surgery, Table of Contents

CC BY-NC-ND 4.0 · Indian J Plast Surg 2018; 51(01): 054-059
DOI: 10.4103/ijps.IJPS_37_17

Original Article

Association of Plastic Surgeons of India

The reverse dorsal metacarpal artery flap in finger reconstruction: A reliable choice

Jyoshid R. Balan

Sushrutha Institute of Plastic Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, Kerala, India

,

Shaji Mathew

Sushrutha Institute of Plastic Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, Kerala, India

,

Pradeep Kumar

Sushrutha Institute of Plastic Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, Kerala, India

,

Harsh Vardhan

Sushrutha Institute of Plastic Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, Kerala, India

,

Anto Francis

Sushrutha Institute of Plastic Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, Kerala, India

,

V. G. Aniljith

Sushrutha Institute of Plastic Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, Kerala, India

,

Raj Gopal

Sushrutha Institute of Plastic Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, Kerala, India

› Author Affiliations

Abstract

ABSTRACT

Background: The finger skin and soft-tissue defects are reconstructive challenges due to their nature and the intricate extensor apparatus and flexors it protects. The reverse dorsal metacarpal artery (RDMA) is a time-tested option for the reconstruction of the same. Materials and Methods: A total of 14 cases of RDMA flap for finger defects involving proximal to distal phalanx were performed. Thirteen of these patients were male and one patient female and the most common mode of injury was occupational in nature followed by road traffic accident. The overall appearance was assessed for the flap and the donor site. The associated injuries and the range of motion were noted. Results: All but one flap survived completely. One patient had partial distal flap loss, which was tackled with split-thickness skin grafting. The flap size varied from 3.5 cm × 1.5 cm to 9 cm × 2 cm with mean of 6.64 cm × 1.72 cm. The mean age of the patients was 33.4 years. All the patients had acceptable aesthesis. The donor site had no complications and healed with linear scar. Conclusions: RDMA flap is a reliable flap for finger defects reconstruction. The range of movement mainly depends on the associated injury rather than flap transfer alone and to prove this we require doing analysis of range of movement in patients with flap done alone or with associated injuries.

KEY WORDS

Aesthesis - finger defects - reconstruction - reverse dorsal metacarpal artery flap

Full Text

References

REFERENCES
1 Maruyama Y. The reverse dorsal metacarpal flap. Br J Plast Surg 1990; 43: 24-7
2 Quaba AA, Davison PM. The distally-based dorsal hand flap. Br J Plast Surg 1990; 43: 28-39
3 Balan JR. Free toe pulp flap for finger pulp and volar defect reconstruction. Indian J Plast Surg 2016; 49: 178-84
4 Jiao H, Ding X, Liu Y, Zhang H, Cao X. Clinical experience of multiple flaps for the reconstruction of dorsal digital defects. Int J Clin Exp Med 2015; 8: 18058-65
5 Rehim SA, Kowalski E, Chung KC. Enhancing aesthetic outcomes of soft-tissue coverage of the hand. Plast Reconstr Surg 2015; 135: 413e-28e
6 Eberlin KR, Chang J, Curtin CM, Sammer DM, Saint-Cyr M, Taghinia AH. et al. Soft-tissue coverage of the hand: A case-based approach. Plast Reconstr Surg 2014; 133: 91-101
7 Chen SL, Chou TD, Chen SG, Cheng TY, Chen TM, Wang HJ. et al. The boomerang flap in managing injuries of the dorsum of the distal phalanx. Plast Reconstr Surg 2000; 106: 834-9
8 Chen C, Tang P, Zhang X. The dorsal homodigital island based on the dorsal branch of the digital Artery: A review of 166 cases. Plast Reconstr Surg 2014; 133: 519e-29
9 Al-Qattan MM. The cross-digital dorsal adipofascial flap. Ann Plast Surg 2008; 60: 150-3
10 Yan H, Fan C, Zhang F, Gao W, Li Z, Zhang X. et al. Reconstruction of large dorsal digital defects with arterialized venous flaps: Our experience and comprehensive review of literature. Ann Plast Surg 2013; 70: 666-71
11 Zhang X, He Y, Shao X, Li Y, Wen S, Zhu H. et al. Second dorsal metacarpal artery flap from the dorsum of the middle finger for coverage of volar thumb defect. J Hand Surg Am 2009; 34: 1467-73
12 de Rezende MR, Mattar Jr. R, Cho AB, Hasegawa OH, Ribak S. Anatomic study of the dorsal arterial system of the hand. Rev Hosp Clin Fac Med Sao Paulo 2004; 59: 71-6
13 Yang D, Morris SF. Reversed dorsal digital and metacarpal island flaps supplied by the dorsal cutaneous branches of the palmar digital artery. Ann Plast Surg 2001; 46: 444-9
14 Braga-Silva J. Anatomic basis of dorsal finger skin cover. Tech Hand Up Extrem Surg 2005; 9: 134-41
15 Beldame J, Havet E, Auquit-Auckbur I, Lefebvre B, Mure JP, Duparc F. et al. Arterial anatomical basis of the dorsal digito-metacarpal flap for long fingers. Surg Radiol Anat 2008; 30: 429-35
16 Yoon TS, Carrera A, Benito-Ruiz J, Ferreres A, Serra-Renom JM. The anatomic basis of the fourth dorsal metacarpal flap: A cadaveric dissection. J Hand Surg Am 2006; 31: 711-6
17 Omokawa S, Tanaka Y, Ryu J, Kish VL. The anatomical basis for reverse first to fifth dorsal metacarpal arterial flaps. J Hand Surg Br 2005; 30: 40-4
18 Sebastin SJ, Mendoza RT, Chong AK, Peng YP, Ono S, Chung KC. et al. Application of the dorsal metacarpal artery perforator flap for resurfacing soft-tissue defects proximal to the fingertip. Plast Reconstr Surg 2011; 128: 166e-178e
19 Koch H, Bruckmann L, Hubmer M, Scharnagl E. Extended revere dorsal metacarpal artery flap: Clinical experience and donor site morbidity. J Plast Reconstr Aesthet Surg 2007; 60: 349-55
20 Wang P, Zhou Z, Dong Q, Jiang B, Zhao X. Reverse second and third dorsal metacarpal artery flap for repair of distal and middle segment finger soft tissue match. J Reconstr Microsurg 2011; 27: 495-502
21 Gregory H, Heitmann C, Germann G. The evolution and refinements of the distally based dorsal metacarpal artery (DMCA) flaps. J Plast Reconstr Aesthet Surg 2007; 60: 731-9
22 Shen H, Shen Z, Wang Y, Zhang K, Zhang Z, Dai X. et al. Extended reverse dorsal metacarpal artery flap for coverage of finger defects distal to the proximal interphalangeal joint. Ann Plast Surg 2014; 72: 529-36
23 Bermel C, Saalabian AA, Horch RE, Dörfler A, Alexiou C, Lyer S. et al. Vascularization of the dorsal base of the second metacarpal bone: An anatomical study using C-arm cone beam computed tomography. Plast Reconstr Surg 2014; 134: 72e-80e
24 Dauphin N, Casoli V. The dorsal metacarpal arteries: Anatomical study. Feasibility of pedicled metacarpal bone flaps. J Hand Surg Eur Vol 2011; 36: 787-94
25 Saalabian AA, Unglaub F, Horch RE, Kneser U. Free vascularized metacarpal bone graft combined with extended dorsal metacarpal artery flap for phalangeal bone and soft tissue loss: Case report. Arch Orthop Trauma Surg 2012; 132: 137-40
26 Katz TL, Hunter-Smith DJ, Matthew RozenW. Reverse second dorsal metacarpal artery vascularized bone flap for index distal bone loss: A case report. Microsurgery 2016; 36: 250-3