A Modification to Enhance the Survival of the Island FDMA Flap by Adding a Skin Bridge

Abstract

Background: Distal thumb injuries are common in high construction load regions, and it is a challenging task for the plastic surgeon to find the optimum choice that preserves thumb length and provides a sensory substitute to the lost tissue. Introducing first dorsal metacarpal artery flap has solved the dilemma. One drawback is that the flap is susceptible to distal necrosis, which can happen because of tight tunneling or insufficient venous drainage. We combined Foucher and Holevich characteristics to design a flap that promises to solve the problem. Methods: This is a case series that includes 9 patients where we describe a technique that has the potential to enhance the survival of the first dorsal metacarpal artery (FDMA) flap and decreases the rate of distal necrosis via addition of a 5-mm skin bridge to the pedicle and by avoiding tunneling. Distal necrosis of the patients in this study patients was compared with that in a control of 10 patients in whom we did the conventional FDMA flap. Patients were followed for 6 weeks to trace early postoperative complications (infection, dehiscence, and necrosis) and the establishment of protective sensation (pain and temperature). Results: None of our patients had distal necrosis, infection, or dehiscence, and all had protective sensation in the flap. In comparison, 4 patients in the control group developed distal necrosis. Conclusion: FDMA is one of the best choices when it comes to distal thumb reconstruction, but it has the disadvantage of distal necrosis, which might be avoided when using the technique mentioned in this study.

Utility of First Dorsal Metacarpal Artery Flap for Thumb Defects

“…Venous insufficiency, which results in venous congestion, edoema, and other related effects, is one of the most typical side effects of the perforator flap. 16 In our study, we discovered that 17 participants who had injured or crushed thumbs had used the island FDMA technique. The findings revealed less congestion and necrosis in the FDMA flap, with 2 participants (12%) showing necrosis and 15 participants (88%) showing no necrosis at all.…”

“…It was believed that the presence of skin extension in an island flap would help venous drainage, preserve superficial veins, and increase flap survival. 15 An additional significant factor could be the flap's inadequate venous drainage, which would result in distal tip congestion and necrosis. Venous insufficiency, which results in venous congestion, edoema, and other related effects, is one of the most typical side effects of the perforator flap.…”

Open Wound Reconstruction of the Thumb Tip: A Review of Current Literature and Case Reports

“…30 Each group only had 5 cases and thus definitive conclusions cannot be drawn; however, it would support the thought that the racquet style flap might be less prone to vascular compromise due to less compression of the neurovascular bundle, in comparison to the Foucher flap. 31,32 Free Flap from the Great Toe Free tissue transfer can provide an effective solution when there is a large defect that requires substantial coverage, and when local or regional flaps are unsuitable or unavailable. Trauma can damage structures that would otherwise serve as donors to thumb defects, in these cases, free tissue transfer would be the treatment of choice.…”