J Reconstr Microsurg 2011; 27(8): 495-502
DOI: 10.1055/s-0031-1284235
© Thieme Medical Publishers

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

Peiji Wang1 , Zhongliang Zhou1 , Qirong Dong1 , 2 , Bo Jiang1 , Jiaju Zhao1
  • 1Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
  • 2Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
Further Information

Publication History

Publication Date:
21 July 2011 (online)

ABSTRACT

The present study evaluated the clinical efficacy of reverse second and third dorsal metacarpal artery fasciocutaneous flaps for repair of distal- and middle-segment finger soft tissue defects. A total of 14 patients with distal- and middle-segment finger soft tissue defects complicated by exposure of the phalanx or tendon were repaired using second and third dorsal metacarpal artery fasciocutaneous flaps ranging between 2.0 cm × 4.5 cm and 3.0 cm × 7.0 cm. All of the skin flaps survived after surgery. Follow-up data during a 6- to 40-month period showed that the flaps exhibited a satisfactory appearance. They were not fat or clumsy, with a 2-point discrimination of 5 to 9 mm, and there was good recovery of finger function. The donor site was able to be directly sutured without dermoplasty. Pigmented linear surgical streaks appeared in the donor site. The second and third dorsal metacarpal artery fasciocutaneous flaps provide a good approach for the repair of distal- and middle-segment finger soft tissue defects and functional reconstruction because of convenient dissection, little trauma, sufficient use of the dorsal metacarpal artery, large harvested area of the flap, and a good dissection range.

REFERENCES

  • 1 Maruyama Y. The reverse dorsal metacarpal flaps.  Br Plast Surg. 1990;  43 24-27
  • 2 Yousif N J, Ye Z, Sanger J R, Arria P, Gilbert A, Matloub H S. The versatile metacarpal and reverse metacarpal flaps in hand surgery.  Ann Plast Surg. 1992;  29 (6) 523-531
  • 3 Preisser P, Marx A, Klinzing S, Partecke B D. Covering defects of the basal finger area by pedicled flaps anastomosed to the doral metacarpal arteries.  Handchir Mikrochir Plast Chir. 2001;  33 (2) 83-88
  • 4 Kakinoki R, Ikeguchi R, Nakamura T. Second dorsal metacarpal artery muscle flap: an adjunct in the treatment of chronic phalangeal osteomyelitis.  J Hand Surg Am. 2004;  29 (1) 49-53
  • 5 Omokawa S, Tanaka Y, Ryu J, Kish V L. The anatomical basis for reverse first to fifth dorsal metacarpal arterial flaps.  J Hand Surg [Br]. 2005;  30 (1) 40-44
  • 6 Yoon S W, Rebecca A M, Smith A A, Mazaheri M K, Casey W J. Reverse second dorsal metacarpal artery flap for reconstruction of fourth-degree burn wounds of the hand.  J Burn Care Res. 2007;  28 (3) 521-523
  • 7 Lai-jin L, Xu G. The reverse dorsal metacarpal flap: experience with 153 cases.  Ann Plast Surg. 2006;  56 (6) 614-617
  • 8 Henry M. Specific complications associated with different types of intrinsic pedicle flaps of the hand.  J Reconstr Microsurg. 2008;  24 (3) 221-225
  • 9 Zhang W, Zhang Z, Gao S, Chen C. [Repair of finger tissue defect with modified island flap based on reversed dorsal metacarpal artery].  Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010;  24 (6) 718-721
  • 10 de Rezende M R, Mattar Júnior R, Cho A B, Hasegawa O H, Ribak S. Anatomic study of the dorsal arterial system of the hand.  Rev Hosp Clin Fac Med Sao Paulo. 2004;  59 (2) 71-76
  • 11 Yuan F, Yu G, Zhang S. [Applied anatomy of the second dorsal metacarpal artery island flap with double pivot points].  Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2005;  19 (8) 622-625
  • 12 Cheng K M, Hou Z D, Wang Y H, Wang Z T, Ding Z H. Applied anatomy of the design of the dorsal metacarpal flap with cutaneous branches of dorsal metacarpal artery.  Anatomy Research. 2008;  30 210-213
  • 13 Earley M J, Milner R H. Dorsal metacarpal flaps.  Br J Plast Surg. 1987;  40 (4) 333-341
  • 14 Cormack G C, Lamberty B G. The Arterial Anatomy of Skin Flaps. Edinburgh, London, Melbourne, New York: Churchill Livingstone; 1986. 202-207 316-319
  • 15 Wang Y H, Wang Z T, Li C H. Clinical applied anatomy with cutaneous branches of dorsal metacarpal artery flap.  Shandong Medical Journal. 2006;  15 42-43
  • 16 Dautel G, Merle M. Direct and reverse dorsal metacarpal flaps.  Br J Plast Surg. 1992;  45 (2) 123-130
  • 17 Lu L J, Gong X, Liu Z G, Zhang Z X. Retrospective study of reverse dorsal metacarpal flap and compound flap: a review of 122 cases.  Chin J Traumatol. 2006;  9 (1) 21-24
  • 18 Jing H, Liu X Y, Ge B F, Liu K Y, Shi J. The second dorsal metacarpal flap with vascular pedicle composed of the second dorsal metacarpal artery and the dorsal carpal branch of radial artery.  Plast Reconstr Surg. 1993;  92 (3) 501-506
  • 19 Zhang W L, Gao S H, Chen C et al.. [The reverse flap based on two dorsal metacarpal artery for reconstruction of degloved fingertip avulsion].  Zhonghua Zheng Xing Wai Ke Za Zhi. 2010;  26 (3) 175-178
  • 20 Kang A, Xiong M G, Gu H, Wang J H. Clinical application of reverse-flow flaps pedicled with superficial venous trunks.  Chinese Journal of Aestheticc Medicine. 2001;  10 370
  • 21 Chang S M, Chen Z W. Can superficial veins reverse flow through valves in distally based fasciocutaneous flaps?.  Plast Reconstr Surg. 1991;  87 (5) 995-996
  • 22 Yang D, Morris S F. Reversed dorsal digital and metacarpal island flaps supplied by the dorsal cutaneous branches of the palmar digital artery.  Ann Plast Surg. 2001;  46 (4) 444-449

Peiji WangM.D. 

Chief Physician, Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University

1055 Sanxiang Road, Suzhou 215004, China

Email: wangpeiji88@163.com

    >