Clinical Evaluation of Reconstruction of Thumb Defect with First Dorsal Metacarpal Artery Flap. (original) (raw)
Related papers
Journal of Bangladesh College of Physicians and Surgeons
Background: Thumb pulp defects are commonly due to avulsion injuries. The choice of reconstructive procedure for thumb depends on the amount and type of tissue lost. The First Dorsal Metacarpal Artery (FDMA) flap is a versatile method with minimum donor site morbidity which provides protective sensation, adequate length, stability and good mobility. Method: This study was done over a period of 2 years and involved 15 consecutive cases of thumb pulp defects treated at our institution. The patient included 13 men and 2 women ranging in age from 16 to 60 years. The defects were ranged from 2cm x 1.5cm to 5cm x 3cm. Results: All flaps survived completely except one had marginal flap necrosis healed without the need for a secondary procedure. Donor site was covered with full thickness skin graft that healed spontaneously. Conclusion: First dorsal metacarpal artery flap offers a sensate, pliable and versatile coverage for soft tissue defects of the thumb. It provides good functional Resul...
First dorsal metacarpal artery flap for thumb reconstruction: a retrospective clinical study
Strategies in trauma and limb reconstruction (Online), 2009
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, ...
Utility of First Dorsal Metacarpal Artery Flap for Thumb Defects
Indian Journal of Plastic Surgery
Background Reconstruction of thumb tip, while providing a durable and sensate flap, is a challenging task. It is important as thumb accounts for 50% of hand functions. Options for coverage are: healing by secondary intention, local/regional flaps, microsurgical toe wraparound flap, etc. First dorsal metacarpal artery (FDMA) flap is one regional flap that has been used for thumb cover, usually for defects till interphalangeal joint or just distal to it. We present our case series for FDMA flap and its variations for thumb reconstruction. We also report reverse FDMA flap cover for reconstruction of defects over distal phalanx of thumb. Methods The procedure was performed in patients with partial loss of thumb soft tissue in 16 patients presenting during 2017 to 2020. The FDMA flap was performed according to the standard technique. In case after “planning in reverse,” it was seen that the reach of FDMA flap was insufficient, reverse FDMA flap was done. Physiotherapy for index finger an...
International Journal of Research in Orthopaedics, 2019
Background: Reconstruction of complex soft tissue defects of the thumb is a challenging problem. It is very important to reconstruct these defects using sensate flaps as the thumb pulp needs to be sensate for implementing the various functions of the thumb. The aim of this study is to report our experience on the safety and functional outcome of the innervated first dorsal metacarpal artery flap (FDMA) for soft tissue defects of thumb.Methods: During 18 month period, nine patients with a mean age of 29 years, male:female ratio of 8:1 underwent coverage of soft tissue defects of the thumb, of various volar and dorsal defects, using an innervated first dorsal metacarpal artery flap. Indications were postburn deformities and acute trauma. None of the patients had any neurorraphy. Outcome of the Holevich modification of FDMA flap was assessed with regards to survival and function, reachability for different locations of the thumb, recovery of sensation in terms of two-point discriminati...
International Journal of Science and Research Archive, 2021
Finger injuries to the hand with extensive soft tissue defects might be challenging to treat. Typically, the first dorsal metacarpal artery (DMA) flap is used for reconstruction, whereas closure of the donor site is routinely performed with a split-thickness skin graft. The aim of the current study is to present a surgical technique that reports a modified incision, which allows elevation of the first DMA flap for the management of the soft tissue defects of the thumb without requiring a skin graft for coverage of the donor site. A 65-year-old man presented to the emergency department with a crush injury to the thumb. The patient had an extensive skin defect on the dorsal side of the thumb extending circumferentially to the ipsilateral thenar without tendon damages, whereas sensation of the finger was found intact. Surgical intervention was performed within six hours and involved DMA flap transfer through a modified skin incision, which allowed coverage of the donor defect in the in...
Evaluation of versatility and outcomes of the first dorsal metacarpal artery flap in thumb defects
Ulusal Travma Acil Cerrahi Dergisi, 2023
It is clinically vital to determine the best technique to reconstruct thumb defects with satisfactory esthetic and functional outcomes. We aimed to quantitatively present the safety, versatility, limitations, advantages, and functional results of the first dorsal metacarpal artery flap (FDMAF) and evaluate its outcomes in thumb defect reconstruction by comparing it with the other current surgical options. METHODS: A total of 21 patients underwent thumb defect reconstruction. They were evaluated with the following parameters: Etiology, age, timing of reconstruction, flap vitality, Semmes-Weinstein monofilament (SWM) test, static two-point discrimination (2PD) test, pain, cortical reorientation, cold intolerance questionnaire, and Michigan hand outcomes questionnaire. Their functional outcomes were evaluated by comparing their scores with the other current surgical options published in the literature. RESULTS: The mean follow-up period was 22.3 months. The mean pain score of the flap was 0.4±0.6 and no patient had pain in the donor area (range, 0-10). The sensory outcome was "good" (8.6 mm) based on the static 2PD test. The mean SWM test score was 4.02 g. Patient satisfaction was 4.6 according to the Michigan hand outcomes questionnaire (range, 0-5). The cold intolerance questionnaire scores showed that the patients had mild cold intolerance (mean, 10.5; range 0-100). Complete cortical reorientation was seen in 81% of the patients. CONCLUSION: Restoration of the innervation of thumb defects is possible with the FDMAF with high satisfaction rates based on our results. The absence of the microsurgical vessel or nerve repair facilitates the surgery, shortens its duration, and reduces morbidity, reserving the microsurgical options for more complicated cases. Therefore, it can be concluded that the FDMAF is an effective flap with great modifications for complicated thumb defects but surgeons should consider their clinical outcomes and prolonged surgery when choosing which technique to be used.
Plastic Amp Reconstructive Surgery, 2012
Various surgical techniques contribute to repair distal defects of the fingers, especially thumb as traumatic loss, diminishes or eliminates the thumb prehensile abilities and may affect overall hand function. The goal of reconstruction should be maximum restoration of hand function. Being the only opposing digit against the others, when thumb is involved, functional loss maybe more severe than anticipated. Because of its major contribution to overall hand function, correction of deformities involving the thumb is crucial. Adequate length, mobility, stability and sensation are the goals of a functional thumb reconstruction. It appears that the FD-MCA flap is one of the best solutions for cover of simple or complex skin loss of the thumb. Its technical performance is easy, and it gives durable, sensate and stable skin cover.
International Surgery Journal, 2020
Background: Reconstruction of soft tissue defects of the thumb, with exposure of tendon, joint or bone, has been a challenging problem. Surgical options include local, regional or free flaps. Here, we have evaluated the functional and aesthetic outcomes of first dorsal metacarpal artery (FDMA) island flap in reconstruction of various soft tissue defects of the thumb.Methods: Between January 2018 and January 2019, twenty patients with post-traumatic and post-infective thumb defects underwent FDMA flaps. Sensory function was evaluated with static 2 point discrimination and mobility of the thumb was tested by the Kapandji score. The aesthetic outcome was also assessed.Results: The mean defect size was 39.9×19.95 mm. Eighteen flaps survived completely and one had distal flap necrosis and one had superficial epidermal peeling which was treated conservatively. The mean static two-point discrimination was 9.3 mm. Cortical reorientation was complete in 45%. The average Kapandji score was 7....
Foucher's first dorsal metacarpal artery flap for thumb reconstruction: evaluation of 21 cases
The Israel Medical Association journal : IMAJ, 2002
Coverage of part of a soft tissue defect in the thumb, without bone shortening and without long-lasting immobilization in an inappropriate position leading to stiffness, is difficult to achieve To report our experience using Foucher's modification of the first dorsal metacarpal artery flap for thumb reconstruction in 21 cases. Foucher's flap is based on the neurovascular structures of the first dorsal metacarpal artery flap and radial nerve-sensitive branches on the dorsum of the second metacarpal and proximal phalanx. The cause of injury was work-related in all 21 cases. The patients mean age was 37 (range 17-68 years), and mean follow-up was 19 months (range 12-31). Emergency surgery was performed in 13 patients with a time delay after injury of 4-12 hours. The minimum defect was 12 x 18 mm and the maximum 20 x 40 mm. Pedicular length was 55-95 mm. A skin bridge was left intact in 16 cases. In two cases of early postoperative venous congestion and flap loss, a cross-finger...
Cureus
The dorsal metacarpal artery (DMCA) flap is a versatile option in the armamentarium of the reconstructive hand surgeon, especially for resurfacing dorsal finger defects where the flap options are limited. The flap fulfills most of the reconstructive principles such as "to replace like with like" and is simple, reliable, and easy to harvest with minimal donor site morbidity. In this report, we discuss the case of a 37-year-old male patient who presented with a partially healed wound over the right middle finger. Several variations of the DMCA flap have been described in the literature, and these are briefly described here along with their applications and vascular basis.