First dorsal metacarpal artery perforator-based propeller flap: functional anatomy and clinical application in soft-tissue defects of the dorsal hand and digits

Abstract

Background Many approaches have been reported to repair soft-tissue defects of the hand using dorsal metacarpal artery flaps. Use of a perforator-based propeller flap from the first intermetacarpal space to the dorsum of the hand has been described. The aim of this study was to confirm the functional anatomy of a first dorsal metacarpal artery (FDMA) perforator flap. Methods Twenty-nine fixed cadaveric hands were dissected to determine the origin, course, and branches of the FDMA. Clinically, five cases of soft tissue defects of the hand underwent reconstructive surgery using an FDMA perforator-based propeller flap. ResultsThe FDMA was found in 27 specimens (93%). The ulnar branch of the FDMA always supplied the cutaneous perforator (mean ± SD, 4.3 ± 1.6), and the most distal cutaneous perforating branch was found along the metacarpal long axis within 25 mm of the tip of the metacarpal head with high frequency (28/29, 97%). In the two hands that had aplasia of the FDMA, well-developed perforators arose directly from the radial artery and advanced to the metacarpal head. Seven hands (24%) had perforators arising from the palmar arterial system, penetrating through or passing close by the second metacarpal bone. In clinical application, all the flaps survived completely without major complications. Conclusions The FDMA perforator-based propeller flap is minimally invasive and technically simple. It is expected to be a new option for hand reconstruction.

The Oblique Extended Reverse First Dorsal Metacarpal Artery Perforator Flap for Coverage of the Radial-Volar Defect of the Proximal Interphalangeal Joint in the Index Finger: A Case Report

“…Aizawa et al conducted a study to find the FDMA perforator in 29 cadavers. 9 FDMA was found in 27 specimens, and the most distal perforator of FDMA was located mainly in the metacarpal head and neck area.…”

“…Through this method, it is possible to reach the PIPJ defect that is far from the FDMA perforator of the metacarpal neck area compared with the previously introduced FDMA perforator flaps. 8 9 Venous congestion was prevented through elevation of the fascia. By choosing the perforator at the metacarpal neck area rather than the proximal phalanx level, the arterial supply is also more stable, and the flap is easier to elevate and has fewer complications.…”

Morphological study of superficial palmar arch and the significance in clinical operation

“…The first dorsal metacarpal artery flap is commonly used in reconstructive surgery for distal limb defects [18,19]. It comes in different forms, including the island flap, the pedicled flap, and the retrograde flap.…”