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CC BY-NC-ND 4.0 · Indian J Plast Surg 2022; 55(04): 368-375
DOI: 10.1055/s-0042-1759500
Original Article

Utility of First Dorsal Metacarpal Artery Flap for Thumb Defects

Krittika Aggarwal 
1   Department of Burns and Plastic Surgery, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
,
Kuldeep Singh
1   Department of Burns and Plastic Surgery, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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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


Publication History

Article published online:
22 December 2022

© 2022. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Foucher G, Braun JB. A new island flap transfer from the dorsum of the index to the thumb. Plast Reconstr Surg 1979; 63 (03) 344-349
    CrossrefPubMedGoogle Scholar
  • 2 El-Khatib HA. Clinical experiences with the extended first dorsal metacarpal artery island flap for thumb reconstruction. J Hand Surg Am 1998; 23 (04) 647-652
    CrossrefPubMedGoogle Scholar
  • 3 Checcucci G, Galeano M, Zucchini M, Zampetti PG, Ceruso M. Reverse flow first dorsal metacarpal artery flap for covering the defect of distal thumb. Microsurgery 2014; 34 (04) 283-286
    CrossrefPubMedGoogle Scholar
  • 4 Couceiro J, de Prado M, Menendez G, Manteiga Z. The first dorsal metacarpal artery flap family: a review. Surg J (NY) 2018; 4 (04) e215-e219
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Shehata Ibrahim Ahmed M, Salah Ibrahim E, Ibrahim Eltayeb H. Evaluation of versatility of use of island first dorsal metacarpal artery flap in reconstruction of dorsal hand defects. Asian J Surg 2019; 42 (01) 197-202
    CrossrefPubMedGoogle Scholar
  • 6 McGregor AD, McGregor IA. Fundamental Techniques of Plastic Surgery and Their Surgical Applications. 10th ed.. Philadelphia: Churchill Livingstone; 2000: 72
    Google Scholar
  • 7 Brunelli F. Le lambeau dorso-cubital du pouce. Anatomic basis for the dorsal radial flap of the thumb: clinical applications. Ann Chir Main 1993; 12: 105-114
    Google Scholar
  • 8 Brunelli F, Gilbert A. Vascularization of the thumb. Anatomy and surgical applications. Hand Clin 2001; 17 (01) 123-138
    CrossrefPubMedGoogle Scholar
  • 9 Slutsky DJ. First dorsal metacarpal artery flap. In: Slutsky DJ. ed. The Art of Microsurgical Hand Reconstruction. New York: Thieme Publishing Group; 2013: 59-66
    Google Scholar
  • 10 Luan Z, Liu B, Jiang H, Gao F, Yang B. Reverse first dorsal metacarpal artery flap repair of a right thumb epidermis granuloma: a case study. Oncol Lett 2019; 18 (03) 2384-2387
    PubMedGoogle Scholar
  • 11 Wang H, Chen C, Li J, Yang X, Zhang H, Wang Z. Modified first dorsal metacarpal artery island flap for sensory reconstruction of thumb pulp defects. J Hand Surg Eur Vol 2016; 41 (02) 177-184
    CrossrefPubMedGoogle Scholar
  • 12 Chang SC, Chen SL, Chen TM, Chuang CJ, Cheng TY, Wang HJ. Sensate first dorsal metacarpal artery flap for resurfacing extensive pulp defects of the thumb. Ann Plast Surg 2004; 53 (05) 449-454
    CrossrefPubMedGoogle Scholar
  • 13 Delikonstantinou IP, Gravvanis AI, Dimitriou V, Zogogiannis I, Douma A, Tsoutsos DA. Foucher first dorsal metacarpal artery flap versus littler heterodigital neurovascular flap in resurfacing thumb pulp loss defects. Ann Plast Surg 2011; 67 (02) 119-122
    CrossrefPubMedGoogle Scholar
  • 14 Chi Z, Lin D, Chen Y. et al. Routine closure of the donor site with a second dorsal metacarpal artery flap to avoid the use of a skin graft after harvest of a first dorsal metacarpal artery flap. J Plast Reconstr Aesthet Surg 2018; 71 (06) 870-875
    CrossrefPubMedGoogle Scholar
  • 15 Muyldermans T, Hierner R. First dorsal metacarpal artery flap for thumb reconstruction: a retrospective clinical study. Strateg Trauma Limb Reconstr 2009; 4 (01) 27-33
    CrossrefPubMedGoogle Scholar