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

• Lee K
• Jo T
• Jeong W
• Kim J
• Son D
• Choi J

• KMID: 2526652
• DOI: http://doi.org/10.12790/ahm.21.0128

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

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

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  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.

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  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.

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

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  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.

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  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

References

1. Rehim SA, Chung KC. Local flaps of the hand. Hand Clin. 2014; 30:137–51.

2. Maruyama Y. The reverse dorsal metacarpal flap. Br J Plast Surg. 1990; 43:24–7.

3. Foucher G, Braun JB. A new island flap transfer from the dorsum of the index to the thumb. Plast Reconstr Surg. 1979; 63:344–9.

4. de Rezende MR, Mattar Júnior R, Cho AB, Hasegawa OH, Ribak S. Anatomic study of the dorsal arterial system of the hand. Rev Hosp Clin Fac Med Sao Paulo. 2004; 59:71–6.

5. Sebastin SJ, Mendoza RT, Chong AK, et al. Application of the dorsal metacarpal artery perforator flap for resurfacing soft-tissue defects proximal to the fingertip. Plast Reconstr Surg. 2011; 128:166e–178e.

6. Dauphin N, Casoli V. The dorsal metacarpal arteries: anatomical study: feasibility of pedicled metacarpal bone flaps. J Hand Surg Eur Vol. 2011; 36:787–94.

7. Earley MJ. The arterial supply of the thumb, first web and index finger and its surgical application. J Hand Surg Br. 1986; 11:163–74.

8. Ghoraba SM, Mahmoud WH. Outcome of thumb reconstruction using the first dorsal metacarpal artery island flap. World J Plast Surg. 2018; 7:151–8.

9. Satish C, Nema S. First dorsal metacarpal artery islanded flap: a useful flap for reconstruction of thumb pulp defects. Indian J Plast Surg. 2009; 42:32–5.

10. Zhang X, Shao X, Ren C, Zhang Z, Wen S, Sun J. Reconstruction of thumb pulp defects using a modified kite flap. J Hand Surg Am. 2011; 36:1597–603.

11. Balan JR, Mathew S, Kumar P, et al. The reverse dorsal metacarpal artery flap in finger reconstruction: a reliable choice. Indian J Plast Surg. 2018; 51:54–9.

12. Murakami T, Takaya K, Outi H. The origin, course and distribution of arteries to the thumb, with special reference to the so-called A. princeps pollicis. Okajimas Folia Anat Jpn. 1969; 46:123–37.

13. Sherif MM. First dorsal metacarpal artery flap in hand reconstruction. I. Anatomical study. J Hand Surg Am. 1994; 19:26–31.

14. Beldame J, Havet E, Auquit-Auckbur I, Lefebvre B, Mure JP, Duparc F. Arterial anatomical basis of the dorsal digito-metacarpal flap for long fingers. Surg Radiol Anat. 2008; 30:429–35.

15. Couceiro J, de Prado M, Menendez G, Manteiga Z. The first dorsal metacarpal artery flap family: a review. Surg J (N Y). 2018; 4:e215–9.

16. Eski M, Nisanci M, Sengezer M. Correction of thumb deformities after burn: versatility of first dorsal metacarpal artery flap. Burns. 2007; 33:65–71.

17. Karacalar A, Ozcan M. A new approach to the reverse dorsal metacarpal artery flap. J Hand Surg Am. 1997; 22:307–10.

18. Ratcliffe RJ, Regan PJ, Scerri GV. First dorsal metacarpal artery flap cover for extensive pulp defects in the normal length thumb. Br J Plast Surg. 1992; 45:544–6.

19. Webster N, Saint-Cyr M. Flaps based on the dorsal metacarpal artery. Hand Clin. 2020; 36:75–83.

20. Omokawa S, Tanaka Y, Ryu J, Kish VL. The anatomical basis for reverse first to fifth dorsal metacarpal arterial flaps. J Hand Surg Br. 2005; 30:40–4.

21. Yoon TS, Carrera A, Benito-Ruiz J, Ferreres A, Serra-Renom JM. The anatomic basis of the fourth dorsal metacarpal flap: a cadaveric dissection. J Hand Surg Am. 2006; 31:711–6.