The First Dorsal Metacarpal Artery Flap Family: A Review

Couceiro, José; Prado, Marta de; Menéndez, Guillermo; Manteiga, Zaira

doi:10.1055/s-0038-1675369

Cited by 19 publications

(16 citation statements)

References 14 publications

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“…On the other hand, local flaps offer advanced esthetic result as the defect is replaced by "similar" tissue. Especially the DMA flaps outmatch as they offer extra amount of soft tissue availability [3,6,9,[17][18].…”

Section: Resultsmentioning

confidence: 99%

“…Several reconstructive options such as local, regional and free flap transfers have been used including the dorsal metacarpal artery (DMA) flaps [2][3][4]. In particular, the use of the first DMA flap has been widely reported in the indexed literature for the repair of deep soft tissue defects of the thumb [5][6][7][8][9]. However, one of the drawbacks of this flap is related to donor site morbidity, since the donor site defect which remains on the dorsum of the index finger, requires skin graft for coverage from a second donor site [10].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

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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“…The former often requires prolonged immobilization, rehabilitation, and hospitalization. Therefore, a variety of regional flaps based on the dorsal metacarpal arteries (DMCAs) became popular in the 1990s (Couceiro et al, ). These flaps are all useful; however, the donor site requires skin grafts if the flap is large and the appearance is unaesthetic.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, a variety of regional flaps based on the dorsal metacarpal arteries (DMCAs) became popular in the 1990s (Couceiro et al, 2018).…”

mentioning

confidence: 99%

The V‐Y advancement flap based on the dorsal carpal perforators for dorsal metacarpal reconstruction: Anatomical and clinical study

Chen

Zhang

et al. 2020

Clinical Anatomy

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Introduction: Soft-tissue defects on the dorsal hand accompanied by exposed bone and tendon remain a challenge for plastic surgeons. The purpose of this study was to observe the morphological characteristics of the dorsal carpal perforators in the wrist and to design a V-Y advancement flap based on the dorsal carpal perforators. Materials and Methods: Thirty cadaveric hand specimens were dissected to observe the origin, course, branches, and anastomoses of the dorsal carpal perforators, and a V-Y advancement flap was designed based on these perforators. Clinically, nine cases of dorsal hand defects were reconstructed with this flap. Results: The dorsal carpal vascular network was formed by vascular anastomoses along the dorsal carpal branch of the radial artery, dorsal carpal branch of the anterior interosseous artery, ascending branch of the dorsal carpal perforator from the deep palmar arch, direct branch of the radial artery, dorsal carpal branch of the ulnar artery, posterior interosseous artery, and deep palmar branch of the ulnar artery; this network could be divided into a deep vascular network and superficial vascular network according to the anatomical plane. Among the perforators, the third and fourth perforators that pierce out bilaterally from the tendon of the extensor digitorium had a consistent occurrence rate (100%) with an outer diameter of 0.7 ± 0.3 mm and 0.6 ± 0.2 mm, respectively, and thus could be chosen as the vascular pedicle. In clinical applications, all flaps survived completely with excellent color and texture, a satisfactory appearance, and normal movement of the wrist joint. Conclusions: A V-Y advancement flap based on the dorsal carpal perforators can become a useful choice for the repair of dorsal metacarpal defects caused by trauma or dorsal metacarpal arterial flaps.

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“…reported that in their cadaver study, the third and fourth DMAs were not observed in 3% and 14% of the cadavers, respectively. Sebastin et al [5] and Couceiro et al [15] also noted that a preoperative Doppler examination is mandatory when considering the use of DMA flaps. As we mentioned earlier, in our study, the Doppler ultrasound was performed before every operation and the success rate of the operation was also high.…”

mentioning

confidence: 99%

The use of the dorsal metacarpal artery for reconstruction of distal dorsal finger defects: an anatomic study and clinical experience

Lee

Jeong

et al. 2022

Arch Hand Microsurg

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Purpose: Dorsal metacarpal artery (DMA) flaps have been used successfully for distal dorsal finger defects. Some studies have reported inconsistent DMA anatomy, and there have been no studies on the anatomic variation of DMAs in Asian cadavers. Therefore, we evaluated the anatomy of DMA using Korean fresh cadavers and reported the clinical outcomes of the DMA flaps.Methods: In the cadaver study, four human forearms from adult fresh cadavers were dissected. The dorsal metacarpal arteries and their communicating branches were identified. From July 2016 to June 2019, five patients with dorsal finger defects underwent a first DMA (FDMA) flap or a reversed DMA (RDMA) flap.Results: In our cadaver study, the ulnar branch of the FDMA and the second and third DMAs were absent in two of four (50%) of the cadavers. In our case series, five flaps survived, and one had partial necrosis, which healed by the second intention. The mean operation time was approximately 100 minutes, and the mean outpatient follow-up period was 6 months.Conclusion: DMA flaps are a reliable flap for the reconstruction of relatively large soft tissue defects of the dorsal finger. However, in our anatomical study, inconsistency of the anatomy of DMAs was identified. Therefore, preoperative Doppler examination is required to evaluate the anatomy of the DMA before considering the use of DMA flaps.

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The First Dorsal Metacarpal Artery Flap Family: A Review

Cited by 19 publications

References 14 publications

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

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

The V‐Y advancement flap based on the dorsal carpal perforators for dorsal metacarpal reconstruction: Anatomical and clinical study

The use of the dorsal metacarpal artery for reconstruction of distal dorsal finger defects: an anatomic study and clinical experience

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