The Holevich Flap Revisited: A Comparison With the Foucher Flap, Case Series

Abstract

The first dorsal metacarpal artery flap was initially described by Hilgenfeldt, it was designed as a racquet flap by Holevich and modified as an island flap by Foucher and Braun. The objective of the present is to compare the Holevich flap and the Foucher flap in terms of venous congestion and flap necrosis. From 2009 to 2013, ten first dorsal metacarpal artery flaps were performed at our hospital's hand unit. Five of the flaps were Holevich type flaps and five of the flaps were Foucher flaps. There were seven men and three women. The mean age was 47 years for the Foucher flap group (17-67 years), and 48 years for the Holevich flap group (36-61 years). Strength, static two tips discrimination, ranges of motion, satisfaction, cold intolerance, pain, flap congestion and flap necrosis were recorded for both groups. Similar values of strength, pain, range of motion and two tips discrimination were found on both groups. There was a higher incidence of flap congestion and necrosis on the Foucher flap group (two thumbs underwent partial flap necrosis and two underwent venous congestion in three patients). There was also a higher incidence of cold intolerance in the Foucher group (two patients exhibited moderate cold intolerance and one exhibited a severe cold intolerance). A proper statistical analysis was not possible due to the size of the case series. In this small case series the Holevich exhibited less flap necrosis, less venous congestion, and less incidence of cold intolerance than the Foucher flap.

The First Dorsal Metacarpal Artery Flap Family: A Review

“…The major indication for the use of the FDMA flaps is the presence of deep soft tissue injuries around the thumb. 6 The FDMA flaps have also been used to restore thumb sensibility 7 and to treat cold intolerance. 6 8 Foucher and Braun mention the use of this flap to treat venous congestion in replanted thumbs as well.…”

“…The racquet flap technique is very similar to that of the island flap. 6 7 The path of the artery is marked with the Doppler's probe and the dissection is identical to that of the island flap; except for the area of the vascular pedicle. When performing the racquet flap, not only the fascia but also a skin paddle is included, this paddle is around one centimeter wide and it is centered longitudinally on the FDMAu.…”

“…The racquet flap is technically less demanding than island flap, it obviates compressive areas and the venous outflow is probably better. 6 The island flap may provide a slightly better aesthetic outcome.…”

“…The first dorsal metacarpal artery (FDMA) family of flaps consists of several different pedicled flaps which rely on the use of the FDMA, alone or in combination with the second dorsal metacarpal artery. 1 2 3 4 5 6 7 8 These flaps include the island flaps, racquet flaps, and bilobed flaps among others. The use of the aforementioned flaps has been extensively reported in the indexed literature, mainly for the repair of deep soft tissue defects of the thumb.…”

Macrosurgery for fingertip amputations

“…For covering larger areas, we use the first metacarpal island flap [ 7 ]. Raising a racket flap as proposed by Holevich [ 8 ] adds safety regarding venous congestion, once a subcutaneous tunnel is avoided, and can improve cold intolerance, since it transfers more nerve branches to the thumb allowing for a better temperature control [ 9 ].…”