Routine closure of the donor site with a second dorsal metacarpal artery flap to avoid the use of a skin graft after harvest of a first dorsal metacarpal artery flap

Chi, Zhenglin; Lin, Damu; Chen, Yiheng; Xue, Jixin; Li, Shi; Chu, Tinggang; Li, Zhijie

doi:10.1016/j.bjps.2018.01.031

Cited by 13 publications

(12 citation statements)

References 19 publications

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“…Current research shows that the second dorsal metacarpal skin flap is usually designed so as to allow the second metacarpal dorsal artery to serve as the vascular pedicle when repairing small area skin defects in the hand. However, a disadvantage of that design is that it sacrifices the second dorsal metacarpal artery and injures a large amount of tissue (Wang et al, 2011;Chi et al, 2018;Webster and Saint-Cyr, 2020).…”

Section: Introductionmentioning

confidence: 99%

Anatomical Characteristics of Cutaneous Branches Extending From the Second Dorsal Metacarpal Artery

Liu

Deng

Zhang

et al. 2020

Front. Bioeng. Biotechnol.

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Background: A second dorsal metacarpal artery cutaneous branches flap is often used to repair skin defects in the hand. The location of the cutaneous branch of that artery is very critical for the removal of the flap. In this study, we quantitatively analyzed the origin of the cutaneous branches of the second dorsal metacarpalartery and the distribution characteristics of the radial and ulnar side to provide an anatomical basis for designing a flap. Methods: Sixteen upper limb specimens were perfused with latex. Four specimens were infused with ethyl acetate plus plastic, and four specimens were perfused with red latex to create pellucid specimens. The origin, travel paths, and distribution of the cutaneous branches of the second dorsal metacarpal artery were anatomically observed, and we measured the length of the cutaneous branch from the midpoint of the second web space edge. We also measured the diameters and pedicle lengths of the radial and ulnar distributions of cutaneous branches of the second dorsal metacarpal artery. Results: The cutaneous branches of the second dorsal metacarpal artery were mainly clustered at three positions, the second cluster point was at 43.9%, the fourth cluster point was at 61.2%, and the fifth cluster point was at 72.1%. The first cluster point was at 30.8% and the sixth cluster point was at 85.6%. The diameter and pedicle length of the sixth cluster point were the largest. There was no significant difference in the distribution of the diameters and pedicle lengths of the cutaneous branch between the radial and ulnar side. The second dorsal metacarpal artery sent out 1-2 cutaneous branches before the tendon joint, and formed a blood vessel anastomosis with other cutaneous branches located further from the tendon joint. The dorsal branch of the radial nerve in the hand extended a nerve branch at the wrist joint and traveled between the cutaneous branches of the second dorsal metacarpal artery to dominate the corresponding skin. Conclusion: Three clusters in the distal second dorsal metacarpal artery were selected to be the flap pedicle containing a cutaneous nerve for use in repairing a skin defect in the hand and fingers.

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Section: Introductionmentioning

confidence: 99%

Anatomical Characteristics of Cutaneous Branches Extending From the Second Dorsal Metacarpal Artery

Liu

Deng

Zhang

et al. 2020

Front. Bioeng. Biotechnol.

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“…Several surgical options have been reported in the literature including local, regional and free flaps [3,13]. Regional flaps harvested from the forearm offer satisfying coverage but they lead to donor site morbidity [14,15]. Free flaps require microsurgical experience, long operative time and the final sensory outcome is not always as expected [1,16].…”

Section: Resultsmentioning

confidence: 99%

Reconstruction of a soft tissue defect of the thumb using a modified dorsal metacarpal artery flap: A case report study

Konstantinidis¹,

Kotsias²,

Giotis³

et al. 2021

Int. J. Sci. Res. Arch.

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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 index finger with a second DMA perforator flap. 3 months postoperatively, patient’s satisfaction, sensation and range of motion (ROM) of the fingers were assessed using The Michigan Hand Outcomes Questionnaire (MHQ) and the 2-point discrimination (2-PD) test. The patient regained active ROM of the thumb and index along with complete preservation of sensation, while the final cosmetic outcome was satisfactory. The application of this technique allows coverage of both trauma defect and donor site with a single skin incision, providing a successful clinical outcome.

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“…Liu et al and Chi et al are two further authors that took advantage of a perforator‐based flap that was axially rotated on its pedicle to provide the donor site closure of a parascapular flap and a first dorsal metacarpal artery flap respectively (Chi et al, ; Liu et al, ). Again, even if they both did not mention the term “propeller” in their descriptions, the flaps they used can be regarded as “perforator pedicled propeller flaps”.…”

Section: Discussionmentioning

confidence: 99%

“…The flaps were outlined based on two separate perforators identified by the preoperative CT-angiography and hand-held Doppler (right) of a bilobed flap on a fasciocutaneous perforator of the ulnar artery (Hsieh et al, 2004). At that time, the term "propeller", introduced by Hyakusoku 13 years earlier to describe a skin island flap axially rotated around a randomly chosen subcutaneous pedicle to release scar contractures, was still out of the scientific spotlight (Hyakusoku, Yamamoto, & Fumiiri, 1991 (Hallock, 2006;Hyakusoku, Ogawa, Oki, & Ishii, 2007;Teo, 2006) (Chi et al, 2018;Liu et al, 2010). Again, even if they both did not mention the term "propeller"…”

Section: Discussionmentioning

confidence: 99%

Propeller flap donor site closure by means of another propeller flap: A case report and literature review

2019

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Despite some ongoing criticisms, propeller flaps are still gaining popularity among plastic surgeons. The need of skin grafting of the donor site is one of those limitations that sometime affect the beauty and the efficacy of this reconstructive technique. Similar to a classic bi‐lobed skin flap in which the second lobe of the same flap is mobilized to cover the donor site defect of the first lobe, a second, discrete propeller flap can be harvested adjacent to the first, in order to close the first donor site defect, thus avoiding the need for a skin graft. We applied this concept of “sequential” propeller flaps to cover a 4.5 × 4 cm full thickness soft tissue defect at the level of the heel in a 54‐year‐old patient who underwent melanoma excision and sentinel node biopsy.The first and second propeller flaps of 10 × 4.5 cm respectively were rotated on a distal and on a more proximal perforator of the posterior tibial artery (PTA) respectively, obtaining a tension free closure along the entire wound. The post‐operative course was uneventful and the patient returned to full normal activities after 4 weeks. Follow up at 6 months showed a stable reconstruction with no functional deficit. This option, that relies on two separate perforator propeller flaps performed in sequence to obtain complete wound closure, may be kept in mind when dealing with soft tissue defects eligible for propeller flap reconstruction, as long as sizeable perforators in a favorable position are available. Moreover, a brief literature review on propeller flap use in flap donor site closure is also provided.

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Routine closure of the donor site with a second dorsal metacarpal artery flap to avoid the use of a skin graft after harvest of a first dorsal metacarpal artery flap

Cited by 13 publications

References 19 publications

Anatomical Characteristics of Cutaneous Branches Extending From the Second Dorsal Metacarpal Artery

Anatomical Characteristics of Cutaneous Branches Extending From the Second Dorsal Metacarpal Artery

Reconstruction of a soft tissue defect of the thumb using a modified dorsal metacarpal artery flap: A case report study

Propeller flap donor site closure by means of another propeller flap: A case report and literature review

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