Arch Hand Microsurg.  2021 Jun;26(2):118-124. 10.12790/ahm.21.0081.

Reconstruction of the First Web Space Using the Wide-Second Dorsal Metacarpal Artery Perforator Flap

• Choi SH
• Cheon HJ
• Oh SH
• Woo SH

• KMID: 2516156
• DOI: http://doi.org/10.12790/ahm.21.0081

Abstract

Purpose
This study evaluated the functional and aesthetic outcomes of a wide-second dorsal metacarpal artery perforator flap for reconstruction of the first web space of the hand. This flap sets the proximal edge of the extensor retinaculum as the distal limit.
Methods
We measured the preoperative and postoperative angles of the first web space and assessed the quality of the donor site scar in eight patients.
Results
The average flap size was 5.5 × 2.8 cm (range, 5.0 × 1.5 cm to 5.0 × 6.0 cm), and all flaps survived completely. The mean postoperative angle was 53°. The mean Vancouver Scar Scale score of the donor site was 4 points, and the patients had near-normal thickness and vascularity values. There was no distortion of the scar, and patients were satisfied with the scar appearance of the donor site.
Conclusion
The wide-second dorsal metacarpal artery perforator flap is a useful technique to reconstruct large defects of the first web space. It is easy to raise, thin, and pliable, and has excellent color and tissue matching.

Keyword

Hand injuries; Contracture release; Perforator flap; Reconstructive surgical procedures

Figure

• 

  Fig. 1. The illustration of wide-second dorsal metacarpal artery (DMA) perforator flap anatomy. Illustration shows the selected perforator (black asterisk) marked at the metacarpal neck area, representing the pivot point. The proximal edge of the extensor retinaculum is the distal limit of the flap.

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  Fig. 2. (A) Preoperative soft tissue defect of the first web space after a crush injury to the left hand. (B) A 5.0 × 4.0-cm rectangular wide-second dorsal metacarpal artery perforator flap with the proximal edge of the extensor retinaculum as the distal limit. (C) The flap is elevated and the pedicle is identified. (D) Immediate postoperative view. (E) Three months after surgery. The postoperative angle of the first web space was 85° and the Vancouver Scar Scale score was 3 points (pigmentation 2, vascularity 0, pliability 1, and height 0).

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  Fig. 3. (A) Preoperative contracture of the first web space after a crush injury to the right hand. (B) A 5.0 × 1.5 cm wide-second dorsal metacarpal artery perforator flap with the proximal edge of the extensor retinaculum as the distal limit. (C) The flap is elevated and the pedicle is identified. (D) Immediate postoperative view. (E) Twenty-two months after surgery. The postoperative angle of the first web space was 46° and the Vancouver Scar Scale score was 3 points.

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