Dear Editor,
I reviewed the study “Utility of First Dorsal Metacarpal Artery Flap for Thumb Defects,”
by K. Aggarwal and K. Singh, published online in the Indian Journal of Plastic Surgery.[1] The study is well designed and the findings are presented in the discussion section
accompanied by the literature.
The first dorsal metacarpal artery (FDMA) flap is particularly useful for 1st and
3rd finger defects.[2]
[3] The advantages of this flap are that its vascular anatomy is stable, its learning
curve is short, and its donor site morbidity is low.[4] The major disadvantage is venous insufficiency occurring in the flap.[1]
[4] Venous insufficiency and necrosis are inevitable in cases where the width of the
pedicle is narrow and the pedicle is compressed ([Fig. 1]).
Fig. 1 View of a patient who developed partial necrosis after venous insufficiency during
follow-up.
If the FDMA flap is to be designed as an island, the pedicle width should be at least
5 mm to prevent venous insufficiency.[2] In addition, if the flap is to be transferred to the recipient area by tunneling,
it should be ensured that the tunnel width is sufficient. If a skin incision is to
be made without tunneling during the flap transfer phase, the incised skin should
not be resutured on the pedicle. It should be preferable to place a graft on the incision
line ([Fig. 2]).
Fig. 2 The pedicle width should be at least 5 mm to prevent venous insufficiency.
In this study by K. Aggarwal and K. Singh, it was understood that the skin on the
pedicle was incised at the flap inset stage in some patients and sutured again after
flap transfer. After the incision, tissue contraction and edema occurred. When the
edematous contracted tissue is resutured, it compresses the pedicle below, and after
compression, circulation disorder occurs in the flap. This may be the cause of partial
necrosis in some patients in the study. Therefore, pedicle width of at least 5 mm
and the use of a sufficiently wide tunneling technique can prevent venous problems
during flap transfer.[2] If a skin incision is to be made without using a tunnel, the skin should not be
resutured, but the pedicle should be grafted.
