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CC BY-NC-ND 4.0 · J Hand Microsurg 2023; 15(02): 148-151
DOI: 10.1055/s-0041-1731938
Case Report

Reconstruction of a Composite Defect of the Distal Index Finger Using a Chimeric Reverse Flow Second Dorsal Metacarpal Artery Flap: A Case Report

Koichi Yano
1   Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai-ku, Sakai City, Osaka, Japan
,
Yasunori Kaneshiro
1   Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai-ku, Sakai City, Osaka, Japan
,
Megumi Ishiko
1   Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai-ku, Sakai City, Osaka, Japan
,
Seungho Hyun
1   Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai-ku, Sakai City, Osaka, Japan
,
Hideki Sakanaka
1   Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai-ku, Sakai City, Osaka, Japan
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Abstract

The reconstruction for mild tissue loss at the distal part of a finger is challenging. We report about a 29-year-old man presenting with traumatic tissue loss at the distal interphalangeal (DIP) joint of the index finger, including skin, bone, and nerve. Reconstruction using two types of flaps was performed. The dorsal skin flap, nourished by the second dorsal metacarpal artery (SDMA) perforator, was elevated. The vascularized second metacarpal bone, nourished by the SDMA, was also elevated. Using the vascular connection between the DMA and the palmar digital artery (PDA), both flaps were raised to the distal part of the finger, and the pivot point was set at the dorsal proximal phalanx. After arthrodesis of the DIP joint with the vascularized second metacarpal bone, the digital nerve was repaired using the cutaneous nerve in the skin flap, and the skin defect was covered using the perforator flap. The postoperative course, including flap survival and bone union, was uneventful. A good indication for the reconstruction of the distal part of a finger with this technique is when the defect sizes of the skin and bone differ and the vascular connection between the SDMA and dorsal branch of PDA is not injured.

Keywords

dorsal metacarpal artery - perforator - bone graft - chimeric flap


Publication History

Article published online:
15 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Evans DM, Martin DL. Step-advancement island flap for fingertip reconstruction. Br J Plast Surg 1988; 41 (02) 105-111
    CrossrefPubMedGoogle Scholar
  • 2 Gurdin M, Pangman WJ. The repair of surface defects of fingers by trans-digital flaps. Plast Reconstr Surg (1946) 1950; 5 (04) 368-371
    CrossrefPubMedGoogle Scholar
  • 3 Lai CS, Lin SD, Yang CC. The reverse digital artery flap for fingertip reconstruction. Ann Plast Surg 1989; 22 (06) 495-500
    CrossrefPubMedGoogle Scholar
  • 4 Snow JW. The use of a volar flap for repair of fingertip amputations: a preliminary report. Plast Reconstr Surg 1967; 40 (02) 163-168
    CrossrefPubMedGoogle Scholar
  • 5 Lemmon JA, Janis JE, Rohrich RJ. Soft-tissue injuries of the fingertip: methods of evaluation and treatment. An algorithmic approach. Plast Reconstr Surg 2008; 122 (03) 105e-117e
    CrossrefPubMedGoogle Scholar
  • 6 Quaba AA, Davison PM. The distally-based dorsal hand flap. Br J Plast Surg 1990; 43 (01) 28-39
    CrossrefPubMedGoogle Scholar
  • 7 Gajisin S, Zbrodowski A, Grodecki J. Vascularization of the extensor apparatus of the fingers. J Anat 1983; 137 (pt 2) 315-322
    PubMedGoogle Scholar
  • 8 Karacalar A, Ozcan M. A new approach to the reverse dorsal metacarpal artery flap. J Hand Surg Am 1997; 22 (02) 307-310
    CrossrefPubMedGoogle Scholar
  • 9 Vuppalapati G, Oberlin C, Balakrishnan G. “Distally based dorsal hand flaps”: clinical experience, cadaveric studies and an update. Br J Plast Surg 2004; 57 (07) 653-667
    CrossrefPubMedGoogle Scholar
  • 10 Yang D, Morris SF. Vascular basis of dorsal digital and metacarpal skin flaps. J Hand Surg Am 2001; 26 (01) 142-146
    CrossrefPubMedGoogle Scholar
  • 11 Santa-Comba A, Amarante J, Silva A, Rodrigues J. Reverse dorsal metacarpal osteocutaneous flap. Br J Plast Surg 1997; 50 (07) 555-558
    CrossrefPubMedGoogle Scholar
  • 12 Saalabian AA, Unglaub F, Horch RE, Kneser U. Free vascularized metacarpal bone graft combined with extended dorsal metacarpal artery flap for phalangeal bone and soft tissue loss: case report. Arch Orthop Trauma Surg 2012; 132 (01) 137-140
    CrossrefPubMedGoogle Scholar
  • 13 Stahl S, Lotter O, Stahl AS, Schaller HE, Sinis N. Immediate reconstruction of complex hand trauma with iliac crest bone graft and 2 pedicled fasciocutaneous skin flaps: a case report. Eplasty 2010; 10: e21
    PubMedGoogle Scholar
  • 14 Katz TL, Hunter-Smith DJ, Matthew Rozen W. Reverse second dorsal metacarpal artery vascularized bone flap for index distal bone loss: a case report. Microsurgery 2016; 36 (03) 250-253
    CrossrefPubMedGoogle Scholar
  • 15 Maruyama Y. The reverse dorsal metacarpal flap. Br J Plast Surg 1990; 43 (01) 24-27
    CrossrefPubMedGoogle Scholar
  • 16 Sunagawa T, Bishop AT, Muramatsu K. Role of conventional and vascularized bone grafts in scaphoid nonunion with avascular necrosis: a canine experimental study. J Hand Surg Am 2000; 25 (05) 849-859
    CrossrefPubMedGoogle Scholar
  • 17 Gosain A, Chang N, Mathes S, Hunt TK, Vasconez L. A study of the relationship between blood flow and bacterial inoculation in musculocutaneous and fasciocutaneous flaps. Plast Reconstr Surg 1990; 86 (06) 1152-1162
    CrossrefPubMedGoogle Scholar
  • 18 Pelissier P, Casoli V, Bakhach J, Martin D, Baudet J. Reverse dorsal digital and metacarpal flaps: a review of 27 cases. Plast Reconstr Surg 1999; 103 (01) 159-165
    CrossrefPubMedGoogle Scholar