A-0224Dorsal advancement flap to reconstruct nail bed loss in the thumb: a case report

Abstract

Background: The dorsal skin of the hand is well-known to be a real donor site for the dorsal metacarpal artery flap. Apart from the undisputable advantages, these flaps have also some major disadvantages, as: (a) sacrifice of the dorsal metacarpal artery; (b) useful only in covering the soft tissue defects over the proximal half of the long fingers; (c) the impossibility of early postoperative fingers mobilisation, due to the situation of the flap vascular pedicle proximally to the metacarpophalangeal joint. Material and methods: We describe a similar type of flap, as a design and donor area, with the classical metacarpal flap, but which can be used in covering more distally defects in both palmar and dorsal aspect of the long fingers, and allows an early postoperative mobilisation, due to the situation of the vascular pedicle distally to the metacarpophalangeal joint. The blood supply of this flap comes from a well-represented vascular anasthomosis in the proximal half of the long fingers, between the dorsal metacarpal arteries and the palmar common digital arteries or the collateral digital arteries. It is possible to harvest two types of flaps based on these vessels: (a) fasciocutaneous pedicled flaps and (b) fasciocutaneous transposition flaps. Results: The evolution was uneventful in 70% of cases; in 25% of cases we had some temporary venous congestion, which diminished and subsided spontaneously, and in 5% of cases we lost the flaps. In all the cases, the functional rehabilitation started after 24 hours. In conclusion, this flap has some advantages, as: (a) it does not sacrifice the dorsal metacarpal artery; (b) it can reach the most distal regions of the long fingers; (c) the distal location of the vascular pedicle to the metacarpophalangeal joint allows the early postoperative mobilisation of the fingers.