Color Doppler ultrasound assessment for identifying perforator arteries of the second dorsal metacarpal flap

Abstract

Purpose: The second dorsal metacarpal (SDMC) perforator flap has been widely used for the soft tissue reconstruction of the hand. However, it is difficult to identify the depth and branches of the perforators of the second dorsal metacarpal artery (SDMA) using only handheld acoustic Doppler flowmetry (HADF), which is the most common method. The purpose of this study was to compare the results of examination by color Doppler ultrasonography (CDU) with those of HADF and to evaluate the efficacy of CDU for detection of the perforators to be used in the design of the SDMC flap. Methods: Twenty-two healthy volunteers (42 hands) were examined using both CDU and HADF. All locations identified as the perforators of the SDMA by the two examinations were mapped respectively. Results: The total perforator arteries detected with CDU in all hands were 111 branches, 49 branches of which could not be identified with HADF. The average number of perforators of the SDMA per hand found with CDU was 2.8 branches, while that for HADF was only 1.8 branches. The detection rates of the cutaneous perforators of the SDMA by CDU were 100% in the proximal onethird of the second metacarpal and 95% in the distal one-fourth of the second metacarpal. Conclusion: This study demonstrated the superiority of CDU compared with HADF for detection of the perforators of the SDMA. The CDU examination could easily identify the locations of the cutaneous perforators and help in the useful assessment of vascularity for the SDMC flap.

First dorsal metacarpal artery perforator-based propeller flap: functional anatomy and clinical application in soft-tissue defects of the dorsal hand and digits

“…They also described in detail the cutaneous perforators of the second to fourth DMAs, whereas there was no mention of the FDMA, which has the potential for covering more radial defects. Replication studies confirmed the existence of the cutaneous perforators at the level of the second to fourth metacarpal heads [14,15].…”

Reconstruction of the First Web Space Using the Wide-Second Dorsal Metacarpal Artery Perforator Flap

“…Many anatomic studies have proven that the first and second dorsal metacarpal arteries are anatomically constant; thus, the flap has a safe pedicle source. The perforator arises just distal to the juncturae tendinum, and because it arises directly from the branches of the deep palmar arch, the DMAP flap can be raised even if there is no dorsal metacarpal artery [13][14][15][16][17]. Sebastin et al [13] defined the indications of the DMAP flap in palmar defects up to the proximal half of the middle phalanx and dorsal defects up to the proximal distal interphalangeal joint.…”

The first dorsal metacarpal propeller perforator (FDMP) flap for finger reconstruction

“…This report simply extends the literature on this paradigm to include the first webspace region of the hand. Although the present report does not rely on a cadaver study to define perforator locations and dimensions, this FDMA perforator propeller flap is conceptually comparable to DMCA perforator flaps based on metacarpals 2,3 and 4, with its dominant perforator arising at the metacarpal neck [ 7 , 8 ].…”