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CC BY-NC-ND 4.0 · Indian J Plast Surg 2009; 42(01): 032-035
DOI: 10.1055/s-0039-1699309
Original Article
Association of Plastic Surgeons of India

First dorsal metacarpal artery islanded flap: A useful flap for reconstruction of thumb pulp defects

Chetan Satish
Department of Plastic Surgery, K.E.M Hospital, Mumbai - 400 012, India
,
Sunit Nema
Department of Plastic Surgery, K.E.M Hospital, Mumbai - 400 012, India
› Author Affiliations
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Publication History

Publication Date:
15 January 2020 (online)

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ABSTRACT

Thumb pulp defects are commonly due to avulsion injuries. It is very important to reconstruct these defects using sensate flaps as the thumb pulp needs to be sensate for implementing the various functions of the thumb. A very good option for coverage of these defects is the islanded first dorsal metacarpal artery flap. Our study was done over a period of 2 years and involved 9 consecutive cases of thumb pulp defects treated at our institution. The patients included 8 males and 1 female, ranging in age from 16 to 51 years old. The flap size ranged from 2 × 1.5 cm to 5 × 3 cm. We had only one complication in the form of partial flap necrosis, which fortunately healed following debridement without the need for a secondary procedure. All our cases were done under local anesthesia with tourniquet control. All the patients had good fine touch and average two-point discrimination of 6 mm, which was satisfactory. Our good results further reinforce the islanded first dorsal metacarpal artery flap as one the best flaps for sensate reconstruction of thumb pulp defects. It replaces the soft tissue loss at the thumb pulp with minimal donor site morbidity and with good return of thumb pulp sensation.

KEY WORDS

First dorsal metacarpal artery flap - Thumb pulp defect - Sensate flap
 

  • REFERENCES

  • 1 Xarchas KC, Tilkeridis KE, Pelekas SI, Kazakos KJ, Kakagia DD, Verettas DA. Littler's flap revisited: An anatomic study, literature review, and clinical experience in the reconstruction of large thumb pulp defects. Med Sci Monit 2008;14: CR 568-73.
  • 2 Guelmi K, Barbato B, Maladry D, Mitz V, Lemerle JP. Reconstruction of digital pulp by pulp tissue transfer of the toe. Apropos of 15 cases. Rev Chir Orthop Reparatrice Appar Mot 1996;82:446-52.
  • 3 Woon CY, Lee JY, Teoh LC. Resurfacing hemipulp losses of the thumb: The cross finger flap revisited: Indications, technical refinements, outcomes and long-term neurosensory recovery. Ann Plast Surg 2008;61:385-91.
  • 4 Chang SC, Chen SL, Chen TM, Chuang CJ, Cheng TY, Wang HJ. Sensate first dorsal metacarpal artery flap for resurfacing extensive pulp defects of the thumb. Ann Plast Surg 2004;53:449-54.
  • 5 Sherif MM. First dorsal metacarpal artery flap in hand reconstruction. Anatomical study. J Hand Surge Am 1994;19: 26-31.
  • 6 El-Khatib HA. Clinical experiences with extended first dorsal metacarpal artery island flap for thumb reconstruction. J Hand Surge Am 1998;23:647-52.
  • 7 Foucher G, Braun JB. A new island flap transfer from the dorsum of the index to the thumb. Plast Reconstr Surg 1979;63:344-9.
  • 8 Earley MJ. The arterial supply of the thumb, first web and index finger and its surgical application. J Hand Surg 1986;11B:163-74.
  • 9 Ratcliffe RJ, Regan PJ, Scerri GV. First dorsal metacarpal artery flap cover for extensive pulp defects in the normal length thumb. Br J Plast Surg 1992;45:544-6.
  • 10 Earley MJ, Milner RH. Dorsal metacarpal artery flaps. Br J Plast Surg 1987;40:333.