Reverse flow first dorsal metacarpal artery flap for covering the defect of distal thumb

Abstract

Reconstruction of distal thumb injuries still remains a challenge for hand surgeons. Surgical treatment includes the use of local, regional, and free flaps. The purpose of this report is to present the results of the use of a sensitive reverse flow first dorsal metacarpal artery (FDMA) flap. The skin flap was designed on the radial side of the proximal phalanx of the index finger based on the ulnar and radial branch of the FDMA and a sensory branch of the superficial radial nerve. This neurovascular flap was used in five patients to cover distal soft-tissue thumb defects. All flaps achieved primary healing except for one patient in whom superficial partial necrosis of the flap occurred, and the defect healed by second intention. All patients maintained the thumb original length and were able to return to their previous daily activities. The reverse flow FDMA flap is a reliable option to cover immediate and delayed defects of distal thumb, offering acceptable functional and cosmetic outcomes in respect to sensibility, durability, and skin-match.

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

“…In our case, sensate reconstruction was felt beneficial in order to optimise keypinch, minimise the risk of neuroma pain, and best support use of handled tools. The sensory outcome matched that reported for standard and reverse flow FDMA flaps [12,13].…”

A perforator from the ulnar artery and cutaneous nerve of the hypothenar area: An anatomical study for clinical application

“…However, this method leads to hand stiffness because of the reconstructed finger being kept in a bent position for over 2–3 weeks, along with an extremely long period of rehabilitation. Various regional flaps from the same hand have also been introduced, but wide incisional wounds can develop as a result of this method …”

Reverse first dorsal metacarpal artery flap repair of a right thumb epidermis granuloma: A case study

“…A granuloma is a well-defined nodular lesion formed by macrophages and cell-specific infiltration and proliferation (1–5). Reports involving epidermal granulomas in the right thumb of children are rare.…”