The proximal first dorsal metacarpal artery free flap for reconstruction of complex digital defects

Hýža, Petr; Kubek, Tomáš; Veselý, Jiří; Dražan, Luboš; Choudry, Umar

doi:10.1177/1753193412467165

Cited by 9 publications

(2 citation statements)

References 20 publications

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“…Moreover, incorporating the fascia of the first dorsal interosseous muscle provides an additional layer of protection to the pedicle during the transfer. A similar first dorsal metacarpal artery perforator flap with a short pedicle was used to reconstruct 10 complex digital defects by Hyza et al 16 In their study, nine donor sites, all with diameter of less than 2 cm, were closed directly; however, a full-thickness skin graft from the groin was required in one patient with a 2.5-cm donor-site defect. In contrast, we covered all donor sites by means of a rotational rhomboid flap, thus accommodating larger defects of 3. , which shows a traumatic distal thumb defect with exposed and palpable bone reconstructed using a comet flap (above) and distal big toe reconstruction with denuded exposed bone using a comet flap (below), http://links.…”

Section: Discussionmentioning

confidence: 99%

The First Dorsal Metacarpal Artery Perforator Free Flap: The Comet Flap

Abu‐Ghname

Lazo²,

Chade³

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Distal extremity defects pose a particular challenge to the reconstructive surgeon; however, advances in perforator flaps have expanded the potential reconstructive options. In this article, the authors present their experience in reconstructing distal extremity defects using a thin, cutaneous free flap based on the perforator of the first dorsal metacarpal artery: the comet flap. Methods: A retrospective review was performed on all patients who presented with a distal extremity defect and underwent reconstruction using a comet flap between 2015 and 2019. Patient demographics, flap anatomy and harvest, and postoperative course were reviewed and analyzed. Results: A total of 16 patients were included. The mean patient age was 36.5 years. Trauma was the most common cause. The average defect size was 5.4 × 3.2 cm. The average pedicle length of the comet flap ranged from 3.5 to 30 cm, depending on involvement of the radial vessels. All donor sites underwent uncomplicated closure with local rhomboid flaps. One flap was complicated by an acute venous thrombosis that was successfully treated operatively. The flap survival rate was 95 percent. All patients were able to maintain their preoperative range of motion and were satisfied with their final outcome. Follow-up time ranged from 6 to 50 months. Conclusions: Local flaps remain an important reconstructive approach for distal extremity defects; however, in complex soft-tissue injuries, free tissue transfers become necessary. The comet flap is a safe, versatile, and reliable flap for reconstructing upper and lower extremity defects that can be performed in a single procedure under regional anesthesia. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Section: Discussionmentioning

confidence: 99%

The First Dorsal Metacarpal Artery Perforator Free Flap: The Comet Flap

Abu‐Ghname

Lazo²,

Chade³

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…Another good option would be the “kite flap,” a pedicled first dorsal metacarpal artery flap, originally described by Foucher and Braun. Hyza et al (2013) used this flap recently in 10 consecutive patients, with good patient satisfaction and no loss of these flaps. In our case series, we used a variation of the homodigital neurovascular island flap.…”

Section: Discussionmentioning

confidence: 99%

The pulp switch flap: An option for the treatment of loss of the dominant half of the digital pulp

Silva

Pires

Teixeira

2013

J Hand Surg Eur Vol

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The fingertip has an important role in bi-digital pinch quality, and pulp loss is common and difficult to solve. The pulp switch consists of a pulp island flap with a homodigital neurovascular pedicle, vascularized by the palmar digital artery of the non-dominant pulp transposed to the dominant pulp side. We report the results in 16 patients treated for loss of the dominant half of a digital pulp from January 2000 to December 2008. On review after a minimum of 6 (range 6-18) months, the Weber's test demonstrated an average of 8 mm in static 2 point discrimination test for all digits, except the ring finger. In the monofilament Semmes-Weinstein test, we obtained a score of 3.61 for the thumb and little fingers, and 4.31 for the other fingers. We did not find partial or total necrosis of the flap. The pulp switch flap gave satisfactory functional results for viability, sensitivity, and digital mobility providing a sensate bi-digital pinch with acceptable aesthetic results in a single surgical procedure.

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