Reverse Second and Third Dorsal Metacarpal Artery Fasciocutaneous Flaps for Repair of Distal- and Middle-Segment Finger Soft Tissue Defects

Background: Complex soft tissue defects of thumb and first web space are a reconstructive challenge. Low voltage electric burns of the hand commonly result in localised and deep soft tissue destruction. The first dorsal metacarpal artery flap (FDMA) is an attractive local flap option to reconstruct these. This study illustrates our experience with the same.Methods: Between March 2014 and February 2017, 16 patients with complex soft tissue defects of thumb and first web space resulting from low voltage electric burns underwent reconstruction with the FDMA flap and subsequent structured hand therapy. In the follow up visits objective assessment of hand function included tests of mobility using Kapandji Score, sensory evaluation with static 2 point discrimination and cortical reorientation. The Subjective Satisfaction Score was used to ascertain the patient’s overall perception of aesthetic and functional outcome.Results: Majority (43.75%) of the patients had defects involving the thumb IP joint. No case of complete flap failure was noted. In a mean follow-up of 11.5 months the reconstructed thumb showed return of good protective sensation as well as mobility. Though cortical reorientation was complete in only 18.75 %, it did not substantially impede hand functioning. All patients were satisfied with the functional and aesthetic result.Conclusions: In cases of low voltage electric burn injuries the FDMA flap is a reliable reconstructive option for small to moderate sized complex defects of thumb and first web space. It has minimal donor site morbidity and can be accomplished in a relatively simple single stage procedure.

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The Bilobed Racquet Flap or Extended Seagull Flap for Thumb Reconstruction: A Case Report

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835518720050 ◽

2018 ◽

Vol 23 (01) ◽

pp. 128-131

Author(s):

José Couceiro ◽

Mariangeles De la Red-Gallego ◽

Luis Yeste ◽

Higinio Ayala ◽

Manuel Sanchez-Crespo ◽

...

Keyword(s):

Case Report ◽

Soft Tissue ◽

Soft Tissue Defects ◽

Thumb Reconstruction ◽

Degloving Injury ◽

Dorsal Metacarpal Artery ◽

The Subject ◽

Tissue Defects

The treatment of extensive soft tissue defects in the thumb with dorsal metacarpal artery flaps has been previously reported in the literature. Island flaps from the dorsum of the index and long fingers have been the subject of many reports and studies. However, when the defect involves the whole thumb, a 360° circumferential defect, standard first or second dorsal metacarpal artery flaps are usually insufficient. There are fewer reports on the use of bilobed flaps for this application and we have found no reports on the use of bilobed racquet flaps or extended seagull flaps as treatment for this condition. We report the salvage of a thumb degloving injury with use of a bilobed racquet flap.

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Versatility of Local Fasciocutaneous Flaps for Coverage of Soft Tissue Defects in Upper Extremity

Journal of Hand and Microsurgery ◽

10.1007/s12593-011-0040-0 ◽

2016 ◽

Vol 03 (02) ◽

pp. 58-62 ◽

Cited By ~ 3

Author(s):

Babak Davami ◽

Golnar Porkhamene

Keyword(s):

Soft Tissue ◽

Upper Extremity ◽

Soft Tissue Defects ◽

Fasciocutaneous Flaps ◽

Tissue Defects

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Reconstruction of soft tissue defects in the Achilles tendon region with perforator-based fasciocutaneous flaps

European Journal of Plastic Surgery ◽

10.1007/s00238-013-0872-x ◽

2013 ◽

Vol 36 (11) ◽

pp. 701-706 ◽

Cited By ~ 1

Author(s):

Nabi Mopuri ◽

Vasu Karri ◽

Nakul Patel ◽

Niri Niranjan

Keyword(s):

Soft Tissue ◽

Achilles Tendon ◽

Soft Tissue Defects ◽

Fasciocutaneous Flaps ◽

Tissue Defects

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The Holevich modification of the first dorsal metacarpal artery flap in coverage of thumb skin losses

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20194820 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1144

Author(s):

Prakash Panagatla ◽

Sindhuri Kondapavuluri ◽

Parvathi Ravula

Keyword(s):

Soft Tissue ◽

Range Of Motion ◽

Soft Tissue Defects ◽

Average Hospital ◽

Sensory Recovery ◽

Dorsal Metacarpal Artery ◽

The Mean ◽

And Function ◽

Tissue Defects ◽

First Dorsal Metacarpal Artery

Background: Reconstruction of complex soft tissue defects of the thumb is a challenging problem. It is very important to reconstruct these defects using sensate flaps as the thumb pulp needs to be sensate for implementing the various functions of the thumb. The aim of this study is to report our experience on the safety and functional outcome of the innervated first dorsal metacarpal artery flap (FDMA) for soft tissue defects of thumb.Methods: During 18 month period, nine patients with a mean age of 29 years, male:female ratio of 8:1 underwent coverage of soft tissue defects of the thumb, of various volar and dorsal defects, using an innervated first dorsal metacarpal artery flap. Indications were postburn deformities and acute trauma. None of the patients had any neurorraphy. Outcome of the Holevich modification of FDMA flap was assessed with regards to survival and function, reachability for different locations of the thumb, recovery of sensation in terms of two-point discrimination (2PD), donor morbidity with regards to deformity and range of motion were analysed.Results: The mean size of the defect was 6.7 cm2. Average hospital stay was 5 days. Average time of sensory recovery was 6 months. The mean 2PD was 4 mm (range 2-6 mm). All patients had a normal active range of motion in the donor finger. One of nine patients had distal flap marginal necrosis of 3-4 mm; it healed with debridement and regular dressings over 12 days.Conclusions: The Holevich modification ensures the safety of the innervated FDMA flap in thumb defect coverage with good recovery of sensation.

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Functional and aesthetic outcomes of first dorsal metacarpal artery flap for thumb reconstruction: a prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20202834 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2268

Author(s):

Sujana Ravada ◽

Surya Rao Venkata Mahipathy ◽

Alagar Raja Durairaj ◽

Narayanamurthy Sundaramurthy ◽

Anand Prasath Jayachandiran

Keyword(s):

Soft Tissue ◽

Donor Site ◽

Sensory Function ◽

Soft Tissue Defects ◽

Aesthetic Outcome ◽

Dorsal Metacarpal Artery ◽

The Mean ◽

The Aesthetic ◽

Tissue Defects ◽

First Dorsal Metacarpal Artery

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.

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