Reverse Dorsal Digital and Metacarpal Flaps: A Review of 27 Cases

Pélissier, P.; Casoli, Vincent; Bakhach, Joseph; Martin, Deborah A.; Baudet, J.

doi:10.1097/00006534-199901000-00025

Cited by 88 publications

(57 citation statements)

References 21 publications

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“…Foucher & Braun's article (1979) was the first to describe the flap supplied by the first dorsal metacarpal artery (1DMA) 4 . In reviewing the literature regarding the anatomy of the dorsal arterial system of the hand, we noticed some controversy about the frequency of the dorsal metacarpal arteries (DMAs) [4][5][6][7][8] , the location of the distal cutaneous branches 5,[9][10][11][12] , and the amount of contribution of the dorsal and palmar arterial system to the formation of the DMAs [13][14][15] . Since that information is of extreme importance for the operative procedure to raise the flaps based on the DMAs, we found it to be useful to study the anatomy of the dorsal arterial system, focusing on the controversial aspects of the literature.…”

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confidence: 99%

Anatomic study of the dorsal arterial system of the hand

et al. 2004

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Historically, the dorsal arterial system of the hand received less attention than the palmar system. The studies concerning dorsal arterial anatomy present some controversies regarding the origin and presence of the dorsal metacarpal artery branches. Knowledge of the anatomy of dorsal metacarpal arteries is especially applied in the surgical planning for flaps taken from the dorsum of the hand. The purpose of this study is to analyze the arterial anatomy of the dorsum of the hand, compare our observations with those of previous studies from the literature, and therefore to define parameters for surgical planning for flaps supplied by the dorsal metacarpal arteries.METHOD: Twenty-six dissections were performed at the dorsum of the right hand of 26 cadavers by making a distalbased U-shaped incision. After catheterization of the radial artery at the wrist level, a plastic dye solution with low viscosity and quick solidification was injected to allow adequate exposure of even small vessels. The radial artery and its branches, the dorsal arterial arch, the dorsal metacarpal arteries, the distal and proximal communicating branches of the palmar system, and the distal cutaneous branches were carefully dissected and identified. RESULTS:The distal cutaneous branches originating from the dorsal metacarpal arteries were observed in all cases; these were located an average of 1.2 cm proximal from the metacarpophalangeal joint. The first dorsal metacarpal artery presented in 3 different patterns regarding its course: fascial, subfascial, and mixed. The branching pattern of the radial artery at the first intermetacarpal space was its division into 3 branches. We observed the presence of the dorsal arterial arch arising from the radial artery in 100% of the cases. The distance between the dorsal arterial arch and the branching point of the radial artery was an average of 2 cm. The first and second dorsal metacarpal arteries were visualized in all cases. The third and fourth dorsal metacarpal arteries were visualized in 96.2% and 92.3% of cases, respectively. There was proximal and distal communication between the dorsal arterial arch and the palmar system through the communicating branches contributing to the dorsal metacarpal artery formation.CONCLUSION: At the dorsum of the hand there is a rich arterial net that anastomoses with the palmar arterial system. This anatomical characteristic allows the utilization of the dorsal aspect of the hand as potential donor site for cutaneous flaps.

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confidence: 99%

Anatomic study of the dorsal arterial system of the hand

et al. 2004

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“…Pelissier and Casoli et al, 28 in their series of 27 patients, were the first who described pedicled island reverse flaps based on the dorsal branches of the propria digital artery to cover different digital defects. Previous well-conducted anatomical studies 3,5,12,23,26,30,33 provided the robust anatomical background for the design of such flaps.…”

Section: Other Dap-like Series (Included Studies Using the Dorsal Bramentioning

confidence: 99%

Predictable Pattern Digital Artery Perforator Flap

Kostopoulos

Agiannidis

Konofaos

et al. 2016

Hand (New York, N,Y.)

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Background: The proper digital arteries as any other axial vessel give rise to multiple cutaneous perforators either volar or dorsal along their course. Their identification is performed with Doppler flowmetry. The vasculo-cutanotendino-osseous complex (VCTOC), which was described by the senior authors, was responsible for the vascularization of all digital anatomic structures (extensor apparatus, skin, periosteum). Their consistent appearance to well measured distances from the digital joints led the way to the present clinical study for highlighting this described anatomy in-vivo and demonstrating the predictability in digital artery perforator (DAP) flap harvest. Methods: From November 2012 to March 2014, fifteen patients underwent reconstruction with a predictable pattern digital artery perforator flap (PPDAP), based on the previously described VCTOC mapping, for digital lesions secondary to tumor extirpation. Flaps were designed as V-Y advancement or propeller type. Postoperative control concerned flap viability and digital function. Results: Seven males and 8 females underwent elective surgery using PPDAP flaps for digital defects following tumor extirpation. The diameter of the defect ranged from 0.5 to 1.5 cm. The vast majority of the lesions were identified on the right hand, the index, the ring finger and the distal phalanx. All flaps survived without signs of venous congestion. No functional digital problems were observed during follow up (mean of 77 months). A minor wound dehiscence presented in one patient. Conclusions: Authors introduced the concept of a "predictable pattern" in the surgery of perforator flaps in the digits. These flaps are reliable and could be a valuable reconstructive option.

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“…It has a constant anatomy and can better match the contours of the hand [7][8][9][10][11]21,22]. As burn reconstruction purpose, reverse-flow DMCA flaps used in thumb, and index finger [23,24].…”

Section: Discussionmentioning

confidence: 99%

The use of reverse-flow dorsal metacarpal artery flaps after postburn metacarpophalangeal joint flexion contracture release

2010

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AbstractWhen thermal injuries of the hand are managed inappropriately, complex hand contractures are inevitable. Patients with hand contractures may have many difficulties in their daily life because of this deformity. These patients are challenging to reconstructive surgeons. In this study we evaluated reverse-flow dorsal metacarpal artery flaps for the defects occurred after metacarpophalangeal joint contracture release of different fingers. Nineteen patients with defects on the volar surface of metacarpophalangeal joint were reconstructed by the reverse-flow dorsal metacarpal artery flaps. All operations were successful and flap losses were not seen. The DMCA flaps provide one stage coverage and permit primary closure of the recipient site. The aesthetic and functional results are satisfactory without sacrificing main arteries. The only drawback is the residual scar on the dorsum of the hand, which can be treated by conservative means and may improve over time.

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Reverse Dorsal Digital and Metacarpal Flaps: A Review of 27 Cases

Cited by 88 publications

References 21 publications

Anatomic study of the dorsal arterial system of the hand

Anatomic study of the dorsal arterial system of the hand

Predictable Pattern Digital Artery Perforator Flap

The use of reverse-flow dorsal metacarpal artery flaps after postburn metacarpophalangeal joint flexion contracture release

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