Free and Island First Dorsal Metacarpal Artery Flaps in Finger Reconstruction

The first dorsal metacarpal artery (DMA) flap was described by Holivich in 1963 for hand reconstruction as a neurovascular island flap. The DMA flap is very thin and small, and that is why this flap is very useful in finger reconstruction. In this study, the authors presented the use of free and island MDA flaps in finger reconstruction.

There was clinical experience of 6 reconstructions using MDA flaps for replacement of soft tissue defects in the fingers. In two cases, the authors used an MDA flap as a free vascularized flap for reconstruction of soft tissue defects in the distal and middle parts of the index. In four cases, they used an MDA flap as an island flap for replacement of soft tissue defects of the thumb. All flaps were used as neurovascular flaps. The first MDA was dissected from the radial artery in the snuffbox with a diameter of about 2 mm. In both cases with free MDA flaps, a subcutaneous vein was used, based on the cephalic vein. The microvascular anastomosis was made between the metacarpal arteries and subcutaneous veins. In all cases, they used dorsal branches from the superficial radial nerve. The maximum size of the MDA flap was 6 × 2.5 cm; the minimum size was 2.5 × 1.5 cm.

All flaps survived completely with good aesthetic appearance. The donor site was closed primarily in 4 cases and with a full thickness-skin graft in 2 cases. Restoration of sensation was observed 1 month after free MDA flap transfer.

The MDA flap is a good choice for replacement of soft tissue defects in finger reconstruction. For replacement of the thumb's soft tissue defects, the authors prefer an island MDA flap. For reconstruction of index distal and middle parts, they prefer a free vascularized MDA flap.