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Two new indications for the use of the first dorsal metacarpal artery (1st DMA) in reconstruction following severe hand injury are reported. In the first case, a primary pollicization of the index finger was based solely on the dorsal arterial network. The second case involves a microvascular arterial revascularisation of a 1st dorsal metacarpal artery island flap. Neither procedure has previously been described.

This case report describes the salvage of an avascular thumb by retrograde venous arterialization. The thumb survived with a 30 percent tissue loss at the radial aspect. Soft-tissue reconstruction and contour correction were achieved with a new microvascular free flap--the free "kite" flap--from the contralateral index finger. Aesthetic and functional results were excellent, and the patient returned to his original occupation. It can be concluded that retrograde arterialization can provide successful salvage in replantation and revascularization under favorable circumstances.