Abstract
Background Reconstruction of thumb tip, while providing a durable and sensate flap, is a challenging
task. It is important as thumb accounts for 50% of hand functions. Options for coverage
are: healing by secondary intention, local/regional flaps, microsurgical toe wraparound
flap, etc. First dorsal metacarpal artery (FDMA) flap is one regional flap that has
been used for thumb cover, usually for defects till interphalangeal joint or just
distal to it. We present our case series for FDMA flap and its variations for thumb
reconstruction. We also report reverse FDMA flap cover for reconstruction of defects
over distal phalanx of thumb.
Methods The procedure was performed in patients with partial loss of thumb soft tissue in
16 patients presenting during 2017 to 2020. The FDMA flap was performed according
to the standard technique. In case after “planning in reverse,” it was seen that the
reach of FDMA flap was insufficient, reverse FDMA flap was done. Physiotherapy for
index finger and thumb was started on day 10. Patient satisfaction, in terms of cosmesis
and function was recorded (graded as poor, good, and very good). Static two-point
discrimination (2-PD) was assessed at 6 months' follow-up. Patients were followed
up for 6 months.
Results The operative time was 1 to 2 hours. Out of total 16 cases, 8 patients underwent
racquet-shaped (intact skin paddle) FDMA flap. Islanded flap was performed in five
and reverse FDMA flap in three. Twelve patients had uneventful recovery and four patients
(three islanded and one reverse FDMA) had partial skin loss. Static 2-PD was assessed
at the 6 months postoperative period.
Conclusion FDMA flap is a useful regional flap for thumb reconstruction. It provides good supple,
durable, and sensate cover. The reverse FDMA flap that increases the pedicle length
can be used for more distal defects, where conventional FDMA flap is doubtful.
Keywords
reconstruction - FDMA - thumb - flap
