Repair of Middle and Distal Finger Skin and Soft Tissue Defect with Dorsal Metacarpal Artery Reversed Island Flap

Introduction: The dorsal metacarpal reversed island flaps have been described for use in a variety of clinical situations. These skin flaps were planned on the dorsum of intermetacarpal space based on the vascular anastomoses between the terminal branches of the dorsal metacarpal artery and the dorsal digital branches of the digital common artery at the level of finger web. We usually use the flap to cover the proximal finger skin and soft tissue defect. However, is the flap for distal middle finger skin and soft tissue defect feasible and reliable?

Methodology and Material: From May 2012 to June 2013, 21 cases of middle and distal finger skin and soft tissue defect were treated with dorsal metacarpal artery reversed island flap which was designed on the dorsal hand pedicled by dorsal metacarpal artery. The flap was then elevated and rotated at the point where digital common artery was anastomosed with the terminal branch of the dorsal metacarpal artery. The donor site was covered directly.

Results: Except 1 case was suffered with distal ⅓ skin flap necrosis, others were well developed. Postoperative follow-up period was 4 to 15 months. All these flaps recovered with satisfying appearance and quality, ROM of metacarpalphangeal and interphalangeal joint of the injured finger was good.

Conclusions: Dorsal metacarpal artery reversed island flap transfer is an ideal method for repairing middle and distal finger skin and soft tissue defect. The surgery is simple. Reliable blood supply without sacrificing the primary artery and nerve. There is minor donor site damage and very few complications.