Neurotized first dorsal metacarpal artery flap for reconstruction of thumb defects: does it helps to improve sensory outcomes?


  • Mahesh Jangra Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
  • Atul Parashar Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
  • Tarush Gupta Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India



Thumb pulp defect, First dorsal metacarpal artery, Radial sensory nerve, Island flap, Thumb degloving injury


Restoration of tactile sensation after reconstruction of a thumb pulp defect is important for hand function. We have evaluated the functional, sensory and aesthetic outcomes of neurotized first dorsal metacarpal artery (FDMA) flap in reconstruction of various soft tissue defects of the thumb. For a period of 18 months (January 2021 to June 2022), a total of 20 patients were considered for the study and divided into two groups that is neurotized (group A) and conventional (group B) FDMA flaps. One flap in each group underwent complete necrosis. Results were compared with patients treated by the conventional Foucher’s FDMA flap without nerve repair. At the final follow-up, flap sensation was assessed using static two-point discrimination and Semmes–Weinstein monofilament (SWM) testing. The mean values for active range of motion, total time for procedure, average time to return to routine work and time period of cortical reorientation were statistically significantly different from the values in the control group (p value <0.05). 2-PD, SWM and cold severity score were found to be statistically non-significant. Neurotized FDMA island flap provides a stable, sensate and reliable option for sensory reconstruction of thumb pulp defects with earlier cortical reorientation that allows easier physical rehabilitation and earlier ability to return to previous work to the patients.


Lai CH, Lai CS, Huang SH, Lin SD, Chang KP. Free medial plantar artery perforator flaps for resurfacing of thumb defects. Ann Plast Surg. 2010;65:535-40.

Ray E, Sherman R, Stevanovic M. Immediate reconstruction of a non replantable thumb amputation by great toe transfer. Plast Reconstr Surg. 2009;123:259-67.

Prabhu M, Powar R, Sulhyan SR. FDMA flap: a versatile technique to reconstruct the thumb. Int J Pharm Med Bio Sci. 2013;2:8-14.

Rehim SA, Chung KC. Local flaps of the hand. Hand Clin. 2014;30:137-51.

Woon CY, Lee JY, Teoh LC. Resurfacing hemipulp losses of the thumb: The cross -finger flap revisited: Indications, technical refinements, outcomes and long-term neurosensory recovery. Ann Plast Sur. 2008;61:385-91.

Xarchas KC, Tilkeridis KE, Pelekas SI, Kazakos KJ, Kakagia DD, Verettas DA. Littler’s flap revisited: An anatomic study, literature review, and clinical experience in the reconstruction of large thumb pulp defects. Med Sci Monit. 2008;14:568-73.

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;53:449-54.

Mahmoud WH. Radial Forearm Flap versus Radial Adipofascial Perforator Based Flap for Reconstruction of Hand Soft Tissue Defects. Donn J Med Med Sci. 2015;2:019-25.

Ali A, Farag M, Safe K. Reconstruction of Hand and Forearm Defects by Abdominal Thin Skin Flaps. Egypt J Plast Reconstr Surg. 2007;31:181-5.

Adani R, Cardon LJ, Castagnetti C, Pinelli M. Distal thumb reconstruction using a mini wrap-around flap from the great toe. J Hand Surg. 1999;24:437-42.

Foucher G, Braun JB. A new island flap transfer from the dorsum of the index to the thumb. Plast Reconstr Surg. 1979;63:344-9.

Ghoraba SM, Mahmoud WH. Outcome of thumb reconstruction using the first dorsal metacarpal artery Island flap. World J Plast Surg. 2018;7:151-2.

Muyldermans T, Hierner R. First dorsal metacarpal artery flap for thumb reconstruction: a retrospective clinical study. Strategies Trauma Limb Reconstr. 2009;4(1):27-33.

Ravada S, Mahipathy SRV, Durairaj AR, Sundaramurthy N, Jayachandiran AP. Functional and aesthetic outcomes of first dorsal metacarpal artery flap for thumb reconstruction: a prospective study Int Surg J. 2020;7(7):2268-74.

Ege A, Tuncay I, Çetin Ö. Foucher’s first dorsal metacarpal artery flap for thumb reconstruction: evaluation of 21 cases. Isr Med Assoc J. 2002;4:421-3.

Feng SM, Sun QQ, Cheng J, Wang AG, Li CK. Superficial radial nerve transection improves sensory outcomes in first dorsal metacarpal artery flaps. Plast Reconstr Surg. 2017;140:558-64.

Zhang X, Shao X, Ren C, Zhang Z, Wen S, Sun J. Reconstruction of thumb pulp defects using a modified kite flap. J Hand Surg Am. 2011;36:1597-603.

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. 2016;41:177-84.

Keramidas E, Rodopoulou S, Metaxotos N, Panagiotou P, Iconomou T, Ioannovich J. Reverse dorsal digital and intercommissural flaps used for digital reconstruction. Br J Plast Surg. 2004;57:61-5.

Pan XG, Tian WC, Guan TX. A clinical study on the extended reverse digital artery island flap [in Chinese]. Zhonghua Zheng Xing Wai Ke Za Zhi. 2004;20:33-4.

Zhao M, Shao X, Tian D, Zhang J, Han J, Zhao F. Repair of defect on finger skin with reverse fascial pedicle island flap of dorsal branch of digital artery [in Chinese]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2005;19:453-4.

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;67:119-22.






Case Series