First dorsal metacarpal artery flap cover for extensive pulp defects in the normal length thumb

Ratcliffe, Robert; Regan, Padraic J.; Scerri, G.V.

doi:10.1016/0007-1226(92)90152-n

Cited by 29 publications

(7 citation statements)

References 14 publications

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“…Ratcliffe et al [ 10 ] described the use of the FDMCA flap to cover extensive pulp defects in the normal-length thumb. In the five patients they reported, there was no morbidity related to the donor area on the dorsum of the index finger, and flap survival was 100%.…”

Section: Discussionmentioning

confidence: 99%

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

Muyldermans

Hierner

2009

Strategies in Trauma and Limb Reconstruction

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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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Section: Discussionmentioning

confidence: 99%

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

Muyldermans

Hierner

2009

Strategies in Trauma and Limb Reconstruction

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“…19 Ratcliffe et al used the FDMA flap to cover defects of the thumb in 5 patients and reported no morbidity related to the donor site. 20 Cil et al advocated that there was no donor site morbidity of FDMA flap in their study. 21 Sherif described the use of 23 FDMA flaps for reconstruction of the first web space and coverage of thumb dorsal surface, thumb palmar surface and hand dorsal surface defects and reported complete flap survival and satisfactory functional and aesthetic outcomes.…”

Section: Discussionmentioning

confidence: 89%

Functional and aesthetic outcomes of first dorsal metacarpal artery flap for thumb reconstruction: a prospective study

et al. 2020

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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 7.9. The aesthetic outcome was excellent in ten, good in eight and poor in two subjects. After a mean follow up period of 11.85 months, most patients regained all functions of the thumb and index finger and were pleased with the cosmetic appearance of the flap and donor site.Conclusions: FDMA flap offers a good quality skin cover for small to moderate sized thumb defects. It is a reliable and versatile flap which is sensate and pliable. It gives excellent functional and aesthetic outcomes with minimal or no donor site morbidity.

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“…Following the initial description by Foucher and Braun, the use of the FDMA flap to cover extensive pulp defects in the normal-length thumb was first described by Ratcliffe et al 15,23 In a study of 23 patients, Sherif reported the use of FDMA flaps to resurface defects of the first web space, thumb palmar and dorsal aspects as well as the dorsal surface of the hand. 24 Eski et al subsequently described its use in treating 14 post-burn thumb contracture.…”

Section: Discussionmentioning

confidence: 99%

Soft tissue reconstruction of low voltage electric burn injuries of the thumb and first web space by the first dorsal metacarpal artery island flap: a three-year study from Eastern India

Gupta

Jash

2020

Int Surg J

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Background: Complex soft tissue defects of thumb and first web space are a reconstructive challenge. Low voltage electric burns of the hand commonly result in localised and deep soft tissue destruction. The first dorsal metacarpal artery flap (FDMA) is an attractive local flap option to reconstruct these. This study illustrates our experience with the same.Methods: Between March 2014 and February 2017, 16 patients with complex soft tissue defects of thumb and first web space resulting from low voltage electric burns underwent reconstruction with the FDMA flap and subsequent structured hand therapy. In the follow up visits objective assessment of hand function included tests of mobility using Kapandji Score, sensory evaluation with static 2 point discrimination and cortical reorientation. The Subjective Satisfaction Score was used to ascertain the patient’s overall perception of aesthetic and functional outcome.Results: Majority (43.75%) of the patients had defects involving the thumb IP joint. No case of complete flap failure was noted. In a mean follow-up of 11.5 months the reconstructed thumb showed return of good protective sensation as well as mobility. Though cortical reorientation was complete in only 18.75 %, it did not substantially impede hand functioning. All patients were satisfied with the functional and aesthetic result.Conclusions: In cases of low voltage electric burn injuries the FDMA flap is a reliable reconstructive option for small to moderate sized complex defects of thumb and first web space. It has minimal donor site morbidity and can be accomplished in a relatively simple single stage procedure.

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First dorsal metacarpal artery flap cover for extensive pulp defects in the normal length thumb

Cited by 29 publications

References 14 publications

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

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

Functional and aesthetic outcomes of first dorsal metacarpal artery flap for thumb reconstruction: a prospective study

Soft tissue reconstruction of low voltage electric burn injuries of the thumb and first web space by the first dorsal metacarpal artery island flap: a three-year study from Eastern India

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