Abstract
The reconstruction for mild tissue loss at the distal part of a finger is challenging.
We report about a 29-year-old man presenting with traumatic tissue loss at the distal
interphalangeal (DIP) joint of the index finger, including skin, bone, and nerve.
Reconstruction using two types of flaps was performed. The dorsal skin flap, nourished
by the second dorsal metacarpal artery (SDMA) perforator, was elevated. The vascularized
second metacarpal bone, nourished by the SDMA, was also elevated. Using the vascular
connection between the DMA and the palmar digital artery (PDA), both flaps were raised
to the distal part of the finger, and the pivot point was set at the dorsal proximal
phalanx. After arthrodesis of the DIP joint with the vascularized second metacarpal
bone, the digital nerve was repaired using the cutaneous nerve in the skin flap, and
the skin defect was covered using the perforator flap. The postoperative course, including
flap survival and bone union, was uneventful. A good indication for the reconstruction
of the distal part of a finger with this technique is when the defect sizes of the
skin and bone differ and the vascular connection between the SDMA and dorsal branch
of PDA is not injured.
Keywords
dorsal metacarpal artery - perforator - bone graft - chimeric flap
