Metacarpal Island Propeller Perforator Flaps for Fingers and Commissural Defects Reconstruction

Introduction: There are a lot of coverage possibilities described for finger and commissural skin defects, and we present here our series of cases reinterpreting a classic, the metacarpal flap, into a modern, metacarpal propeller perforator flap.

Methodology and Material: Our study included 56 patients, 42 males and 14 females, who presented in our clinic with acute or chronic defects in the fingers or web space area.

We noted composite defects in 24 patients, which required additional surgical procedures in the same operating time for fractures, joint injuries, tendon rupture, tendon defects, nerve injuries, infections. For these cases we performed as needed debridement, K wire osteosynthesis, tenoraphy, capsuloraphy, neuroraphy and in 4 cases we included in the flap also a vascularized tendon graft for extensor tendon defects.

The flaps were raised as propeller island perforator flaps, rotated between 90 and 180 degrees. The flaps were mainly harvested from the first and second metacarpal spaces, respecting the functional border of the finger, but we were able to raise flaps also from the third and fourth metacarpal space.

We included a small cuff of soft tissue around the perforator and directly closed the donor site of the flap.

Results: We noted a temporary venous congestion in 3 flaps, which subsided with conservative treatment, and 2 delayed healing in the distal region of the flap.

The patients started mobilization the second day after the surgery and were able to resume work between 4 and 6 weeks, depending on the complexity of the injury. The vascularized tendon grafts were functional in all patients and the bone healing was complete.

Conclusions: Compared with the classical axial flap, the metacarpal island propeller perforator flap has the advantage that the mobilization and reintegration of the patient can start very early after the surgery and compared with the pedicled perforator type of flap, that it does not suffer due to the pedicle compression through tunneling, or does not require skin grafting or secondary pedicle epitelization.