Strategies in Trauma and Limb Reconstruction

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VOLUME 4 , ISSUE 1 ( April, 2009 ) > List of Articles

Original Article

First dorsal metacarpal artery flap for thumb reconstruction: a retrospective clinical study

Thomas Muyldermans, Robert Hierner

Keywords : Hand, Trauma, Thumb, Flap, First dorsal metacarpal artery, Reconstruction

Citation Information : Muyldermans T, Hierner R. First dorsal metacarpal artery flap for thumb reconstruction: a retrospective clinical study. 2009; 4 (1):27-33.

DOI: 10.1007/s11751-009-0056-1

License: CC BY-NC-SA 4.0

Published Online: 01-12-2019

Copyright Statement:  Copyright © 2009; The Author(s).


Abstract

Extensive pulp (zone 4) defects of the thumb, with the exposure of tendon or bone, are challenging reconstructive problems. Surgical treatment includes the use of local, regional, and free flaps. The first dorsal metacarpal artery flap has been used successfully for defects of the thumb. The innerved first dorsal metacarpal artery flap from the dorsum of the index finger was first described by Hilgenfeldt and refined by Holevich. An island flap carried on a neurovascular pedicle consisting of the first dorsal metacarpal artery was first demonstrated by Foucher and Braun. Seven innervated FDMCA island flaps were performed from May 2005 until July 2007 for thumb reconstruction. There were three women and four men with an average age of 54.9 years (range 28–89 years). The mean follow-up period was 15.4 months (range 4–29 months). The dominant hand was involved in six (85.7%) patients. In a retrospective clinical study, the following criteria were evaluated: (1) etiology of the defect, (2) time of reconstruction (primary vs. delayed), (3) survival rate of flap, (4) sensory function (Semmes–Weinstein monofilaments, static 2-PD, pain, cortical reorientation), (5) TAM measured with the Kapandji index, and (6) subjective patient satisfaction (SF 36). Four patients presented with trauma, two patients with defects after tumor resection and one with infection of the thumb. The flap was used for immediate reconstruction in three (42.9%) patients and for delayed reconstruction in four (57.1%) patients. Delayed reconstruction was performed 4.75 (1–12) months after initial trauma or first surgery. The donor area was grafted with full-thickness skin grafts in all cases. All flaps survived. The mean SWMF was 3.31 g and average statis 2-PD over the flap was 10.57 mm. Pain at the flap scored 3.71 over 10 and at the donor site 2.17 over 10. Paresthesia at the flap scored 0.57 over 4 and at the donor site 0.33 over 4. Complete cortical reorientation was only seen in one patient. The mean Kapandji score of the reconstructed thumb was 7.43 over 10. Using the SF-36, mean physical health of the patients scored 66.88% and mean mental health scored 70.55%. Disturbing pain and paresthesia of the flap are exceptional. The static 2-PD is more than 10 mm, and is clinically over the limit. Cortical reorientation was incomplete in all but one patient. Touch on thumb is felt on the dorsum of the index finger; however, sensation is not disturbing or interfering with the patient's activities. Foucher described the technique débranchement–rébranchement in order to improve this problem. The postoperative total amount of motion of the reconstructed thumb was very good. The results demonstrated that the FDMCA flap has a constant anatomy and easy dissection. It has a low donor site morbidity if FTSG is used. It also shows good functional and aesthetic results. Therefore, the FDMCA flap is a first treatment of choice for defects of the proximal phalanx and proximal part of the distal phalanx of the thumb.


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  1. Hilgenfeldt O (1950) Operativer daumenersatz. Enkeverslag, Stuttgart
  2. Holevich J (1963) A new method of restoring sensibility to the thumb. J Bone Joint Surg 45B:496-502
  3. Foucher G, Braun JB (1979) A new island flap transfer from the dorsum of the index to teh thumb. Plast Reconstr Surg 63:344- 349
  4. Gebhart B, Meissl G (1995) An extended first dorsal metacarpal artery neurovascular island flap. J Hand Surg 20B:529-531
  5. Wilhelm K, Putz R, Hierner R et al (1997) Lappenplastiken in der Handchirurgie. Angewandte Anatomie, Operationstechniken, Differentialtherapie. Urban and Scharzenberg, München-Wien- Baltimore
  6. Littler JW (1953) The neurovascular pedicle method of digital transposition for reconstruction of the thumb. Plast Reconstr Surg 12:303-319
  7. Strauch B, Tsur H (1978) Restoration of sensation to the hand by a free neurovascular flap from the first web space of the foot. Plast Reconstr Surg 62:361-367
  8. Buncke HJ, Rose EH (1979) Free toe-to-fingertip neurovascular flaps. Plast Reconstr Surg 63:607-612
  9. Adani R, Cardon LJ, Castagnetti C, Pinelli M (1999) Distal thumb reconstruction using a mini wrap-around flap from the great toe. J Hand Surg 24B:437-442
  10. Ratcliffe RJ, Regan PJ, Scerri GV (1992) First dorsal metacarpal artery flap cover for extensive pulp defects in the normal length thumb. Br J Plast Surg 45:544-546
  11. Sherif MM (1994) First dorsal metacarpal artery flap in hand reconstruction. I. Anatomical study. J Hand Surg 19A:26-31
  12. Sherif MM (1994) First dorsal metacarpal artery flap in hand reconstruction. II. Clinical application. J Hand Surg 19A:26-31
  13. Eski M, Nisanci M, Sengezer M (2007) Correction of thumb deformities after burn: Versatility of first dorsal metacarpal artery flap. Burn 33(1):65-71
  14. Pelissier P, Casoli V, Bakhach J, Martin D, Baudet J (1999) Reverse dorsal digital and metacarpal flaps: a review of 27 cases. Plast Reconstr Surg 103(1):159-165
  15. El Khatib HA (1998) Clinical experiences with the extended first dorsal metacarpal artery island flap for thumb reconstruction. J Hand Surg [Am] 23(4):647-652
  16. Yoshinori O (2000) Sensory function of the neurovascular island flap in thumb reconstruction: comparison of original and modified procedures. J Hand Surg [Am] 25A:637-643
  17. Tränkle M, Sauerbier M, Heitmann C, Germann G (2003) Restoration of thumb sensibility with the innervated first dorsal metacarpal artery island flap. J Hand Surg [Am] 28(5):758-766
  18. Shun-Cheng C, Shao-Liang C, Tim-Mo C, Chia-Jueng C, Tian- Yeu C, Hsian-Jenn W (2004) Sensate first dorsal metacarpal artery flap for resurfacing extensive pulp defects of the thumb. Ann Plast Surg 53(5):449-454
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