Arch Hand Microsurg.  2022 Mar;27(1):72-78. 10.12790/ahm.21.0128.

The use of the dorsal metacarpal artery for reconstruction of distal dorsal finger defects: an anatomic study and clinical experience

Affiliations
  • 1Department of Plastic and Reconstructuve Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea

Abstract

Purpose
Dorsal metacarpal artery (DMA) flaps have been used successfully for distal dorsal finger defects. Some studies have reported inconsistent DMA anatomy, and there have been no studies on the anatomic variation of DMAs in Asian cadavers. Therefore, we evaluated the anatomy of DMA using Korean fresh cadavers and reported the clinical outcomes of the DMA flaps.
Methods
In the cadaver study, four human forearms from adult fresh cadavers were dissected. The dorsal metacarpal arteries and their communicating branches were identified. From July 2016 to June 2019, five patients with dorsal finger defects underwent a first DMA (FDMA) flap or a reversed DMA (RDMA) flap.
Results
In our cadaver study, the ulnar branch of the FDMA and the second and third DMAs were absent in two of four (50%) of the cadavers. In our case series, five flaps survived, and one had partial necrosis, which healed by the second intention. The mean operation time was approximately 100 minutes, and the mean outpatient follow-up period was 6 months.
Conclusion
DMA flaps are a reliable flap for the reconstruction of relatively large soft tissue defects of the dorsal finger. However, in our anatomical study, inconsistency of the anatomy of DMAs was identified. Therefore, preoperative Doppler examination is required to evaluate the anatomy of the DMA before considering the use of DMA flaps.

Keyword

Hand injuries; Finger injuries; Reconstructive surgical procedures; Pedicled flaps

Figure

  • Fig. 1. Diagrammatic presentation of the first dorsal metacarpal artery (FDMA) and its three branches.

  • Fig. 2. A right hand: on the upper side of the figure, a global view; on the lower side, a detailed view of the first intermetacarpal space. The yellow arrow indicates the absence of the ulnar branch of the first dorsal metacarpal artery.

  • Fig. 3. Absent dorsal metacarpal arteries. The red arrows point to the absent second dorsal metacarpal artery (A) and third dorsal metacarpal artery (B) in each intermetacarpal area.

  • Fig. 4. The red arrow points to the communication of the dorsal metacarpal artery and the palmar arch.

  • Fig. 5. Case 1. A 69-year-old woman with squamous cell carcinoma on the nail bed of the right thumb. (A) A thumb nail bed defect. A first dorsal metacarpal artery flap, 3.0×1.8 cm2, was elevated on the dorsum of the index finger. (B) The defect was covered with a flap. (C) One-month postoperative view.

  • Fig. 6. Case 2. A 34-year-old man with a contact burn, extending from the left thumb to the middle finger. (A, B) The skin defect at the tip of the left thumb and ring finger. (C) Reverse dorsal metacarpal artery flap, 4.0×2.5 cm2, from the third-fourth intermetacarpal space covering the tip of the ring finger. A first dorsal metacarpal artery flap, 3.2×2.0 cm2, covered the defect on the tip of the thumb. (D) Two-month postoperative view.


Reference

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