First Web-space Reconstruction Using the Second Dorsal Metacarpal Artery Cutaneous Flap: A Reliable Choice for Large Defects

Abstract

Background First web-space defect reconstruction is challenging for reconstructive surgeons. The second dorsal metacarpal artery (SDMA) flap is useful in treating hand and finger defects. However, limited studies have used it for the first web-space defects. This study reports a modified SDMA flap to treat first web-space soft-tissue defects. Methods From April 2012 to October 2018, 8 patients underwent a modified SDMA flap transfer (mean flap size, 2 × 3 cm to 4 × 6 cm). The average length of the pedicle was 2.9 cm. On average, the flap was rotated 84°. In 6 patients, full-thickness skin was grafted at the donor sites. The donor site was primarily closed in two cases. Results All wounds were healed without complications of flap failure or donor area-related morbidity. The average follow-up period was 7.9 months, and these patients were satisfied with the functional recovery and cosmetic appearance of the scar area. At the end of follow-up, the average movement range of the metacarpophalangeal joint of the thumb, index finger, and long finger were 84°, 88°, and 87°, respectively, while those of the contralateral thumb, index finger, and long finger were 87°, 88°, and 85°, respectively. The first web of the injured side spanned an average of 73°; the measurement on the contralateral side was 91°. Conclusions The SDMA flap reconstruction is a simple and fast procedure with a wide resurfacing range for large first web-space defects, low donor-site morbidity, and good functional and esthetic appearance.