Functional and aesthetic outcomes of first dorsal metacarpal artery flap for thumb reconstruction: a prospective study
Keywords:Thumb defects, Reconstruction, First dorsal metacarpal artery
Background: Reconstruction of soft tissue defects of the thumb, with exposure of tendon, joint or bone, has been a challenging problem. Surgical options include local, regional or free flaps. Here, we have evaluated the functional and aesthetic outcomes of first dorsal metacarpal artery (FDMA) island flap in reconstruction of various soft tissue defects of the thumb.
Methods: Between January 2018 and January 2019, twenty patients with post-traumatic and post-infective thumb defects underwent FDMA flaps. Sensory function was evaluated with static 2 point discrimination and mobility of the thumb was tested by the Kapandji score. The aesthetic outcome was also assessed.
Results: The mean defect size was 39.9×19.95 mm. Eighteen flaps survived completely and one had distal flap necrosis and one had superficial epidermal peeling which was treated conservatively. The mean static two-point discrimination was 9.3 mm. Cortical reorientation was complete in 45%. The average Kapandji score was 7.9. The aesthetic outcome was excellent in ten, good in eight and poor in two subjects. After a mean follow up period of 11.85 months, most patients regained all functions of the thumb and index finger and were pleased with the cosmetic appearance of the flap and donor site.
Conclusions: FDMA flap offers a good quality skin cover for small to moderate sized thumb defects. It is a reliable and versatile flap which is sensate and pliable. It gives excellent functional and aesthetic outcomes with minimal or no donor site morbidity.
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.
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.
Prabhu M, Powar R, Sulhyan SR. FDMA flap: a versatile technique to reconstruct the thumb. Int J Pharm Med Bio Sc. 2013;2:8-14.
Holevich J. A new method of restoring sensibility to the thumb. J Bone Joint Surg. 1963;45:496-502.
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.
Earley MJ. The arterial supply of the thumb, first web and index finger and its surgical application. J Hand Surg. 1986;11:163-74.
Sherif MM. First dorsal metacarpal artery flap in hand reconstruction, I: anatomy study. J Hand Surg. 1994;19:26-31.
Kapandji A. Clinical test of apposition and counter-apposition of the thumb. Ann Chir Main. 1986;5:67-73.
Hurren J, Cormack G. The application of the rotation flap to the dorsum of the hand. Br J Plast Surg. 2000;53:491-4.
Rehim SA, Chung KC. Local flaps of the hand. Hand Clin. 2014;30:137-51.
Biswas D, Wysocki RW, Fernandez JJ, Cohen MS. Local and regional flaps for hand coverage. J Hand Surg Am. 2014;39:992-1004.
Rezende DMR, Junior MR, Cho AB, Hasegawa OH, Ribak S. Anatomic study of the dorsal arterial system of the hand. Rev Hosp Clin Fac Med Sao Paulo. 2004;59:71-6.
Satish C, Nema S. First dorsal metacarpal artery islanded flap: A useful flap for reconstruction of thumb pulp defects. Indian J Plast Surg. 2009;42:32-5.
Khatib EHA. Clinical experiences with the extended first dorsal metacarpal artery island flap for thumb reconstruction. J Hand Surg Am. 1998;23:647-52.
Ege A, Tuncay I, Ercetin O. Foucher’s first dorsal metacarpal artery flap for thumb reconstruction: evaluation of 21 cases. Isr Med Assoc J. 2002;4:421-3.
Muyldermans T, Hierner R. First dorsal metacarpal artery flap for thumb reconstruction: a retrospective clinical study. Strategies Trauma Limb Reconstr. 2009;4:27-33.
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.
Trankle M, Sauerbier M, Heitmann C, Germann G. Restoration of thumb sensibility with the innervated first dorsal metacarpal artery island flap. J Hand Surg. 2003;28:758-66.
Eski M, Nisanci M, Sengezer M. Correction of thumb deformities after burn: Versatility of first dorsal metacarpal artery flap. Burns. 2007;33:65-71.
Ratcliffe RJ, Regan PJ, Scerri GV. First dorsal metacarpal artery flap cover for extensive pulp defects in the normal length thumb. Br J Plast Surg. 1992;45:544-6.
Cil Y, Eski M, Isik S. First dorsal metacarpal artery adipo-fascial flap for thenar burn contracture releasing. Burns. 2008;34:127-30.
Sherif MM. First dorsal metacarpal artery flap in hand reconstruction II Clinical application. J Hand Surg. 1994;19:32-8.