Treatment of Complex Soft-Tissue Defects at the Metacarpophalangeal Joint of the Thumb Using the Bilobed Second Dorsal Metacarpal Artery–Based Island Flap

Zhu, Hongwei; Zhang, Xu; Yan, Mengyang; Sheng, Quanfeng; Wen, Sumin; Ren, Chunzhen

doi:10.1097/prs.0b013e3182865c26

Cited by 8 publications

(9 citation statements)

References 20 publications

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“…While most previous studies have focused on the cutaneous branches at the distal part from the tendon joint, there are usually 1-2 cutaneous branches with a diameter of 0.37 ± 0.11 mm before the tendon joint (Yoon et al, 2007;Zhu et al, 2013;Rozen et al, 2015;van Alphen et al, 2016). The cutaneous branches of the distal and proximal parts of the second dorsal metacarpal artery link with each other, which can increase the length of the vascular pedicle of the flap and enlarge its rotational coverage.…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…This technique is more suitable for the coverage of small-sized web-space defects. Zhu reported the use of bilobed SDMAbased island ap for the reconstruction of complex soft-tissue defects around the MCP joint of the thumb, which was harvested from both the index and long ngers (20). The average size of the aps from the index and long ngers was 2.6 cm × 3.4 cm and 2.8 cm × 3.2 cm, respectively.…”

Section: Discussionmentioning

confidence: 99%

First Web-space Reconstruction Using the Second Dorsal Metacarpal Artery Cutaneous Flap: A Reliable Choice for Large Defects

Tian

Guo

Han

et al. 2020

Preprint

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Background First web-space defect reconstruction is challenging for reconstructive surgeons. The second dorsal metacarpal artery (SDMA) flap is useful in treating hand and finger defects. However, limited studies have used it for the first web-space defects. This study reports a modified SDMA flap to treat first web-space soft-tissue defects. Methods From April 2012 to October 2018, 8 patients underwent a modified SDMA flap transfer (mean flap size, 2 × 3 cm to 4 × 6 cm). The average length of the pedicle was 2.9 cm. On average, the flap was rotated 84°. In 6 patients, full-thickness skin was grafted at the donor sites. The donor site was primarily closed in two cases. Results All wounds were healed without complications of flap failure or donor area-related morbidity. The average follow-up period was 7.9 months, and these patients were satisfied with the functional recovery and cosmetic appearance of the scar area. At the end of follow-up, the average movement range of the metacarpophalangeal joint of the thumb, index finger, and long finger were 84°, 88°, and 87°, respectively, while those of the contralateral thumb, index finger, and long finger were 87°, 88°, and 85°, respectively. The first web of the injured side spanned an average of 73°; the measurement on the contralateral side was 91°. Conclusions The SDMA flap reconstruction is a simple and fast procedure with a wide resurfacing range for large first web-space defects, low donor-site morbidity, and good functional and esthetic appearance.

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“…21 The study by Zhu et al had no flaps complicated by venous congestion with a 100% (n ¼ 13) flap survival rate and notably was the only reported study to perform an intraoperative venous anastomosis. 34 Other less frequently reported complications and results can be found in ►Table 2. Donor site management was achieved by primary closure in the majority of the finger reconstruction studies or use of a skin graft in 8 of the 15 flap types.…”

Section: Digital Defectsmentioning

confidence: 98%

“…A total of 22 articles reported on 15 unique PPFs used in the reconstruction of digital defects for a total of 601 flaps performed. 10,[15][16][17][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] The innervated digital artery perforator (IDAP) flap was the most commonly used flap in 103 of 601 cases (17.1%), followed by the digital artery perforator (DAP) flap in 76 of 601 cases (12.6%). 10,17,22,23,26 A full list of flap types are outlined in ►Table 2.…”

Section: Digital Defectsmentioning

confidence: 99%

“…The most common vessel used for coverage of finger reconstruction was the digital artery used in 442 of 601 cases. 10,[15][16][17][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Dorsal digital defects were primarily covered by the dorsal metacarpal artery perforator flap (n ¼ 47), 23,30 followed by only three volar defects being covered by the same dorsal metacarpal artery perforator flap. 30 The average flap size used for digital reconstruction was 7.2 cm 2 , ranging from 4.7 cm 2 in the DAP flap to 9.9 cm 2 in the reverse dorsal metacarpal artery perforator flap (IQR: 3.5).…”

Section: Digital Defectsmentioning

confidence: 99%

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Propeller Perforator Flaps Used for Hand and Digit Reconstruction: A Systematic Review

Bovill

Huffman

Cach

et al. 2024

Journal of Hand and Microsurgery

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Background Propeller perforator flaps (PPFs) have increased in popularity due to the freedom in design and ability to cover a variety of defects without sacrificing the major vessels. Present reports of PPFs for upper limb reconstruction have not provided guidance for hand reconstruction, specifically. This study aims to review the current literature and evaluate techniques for use of PPFs in hand reconstruction. Methods A comprehensive literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for articles published from 1991 to 2021. The database search was queried for records using appropriate Medical Subject Headings (MeSH) terms. Studies reporting PPFs were limited to English language and excluded lower extremity or upper extremity reconstruction not specific to defects in the hand or digits. Study characteristics, patient demographics, indications, preoperative testing, flap characteristics, flap survival, and complication rates were collected. Results Out of the initial 1,348 citations yielded, 71 underwent full-text review. Ultimately, 25 unique citations were included encompassing 12 retrospective reviews (48%), 3 prospective cohort studies (10%), and 10 case series (40%). In review, 525 patients underwent reconstruction with a total of 613 propeller flaps performed to repair defects of the hand, digits, or both with use of 18 unique flap types. Overall flap survival was 97.8%. Acute wounds accounted for 72.9% of performed reconstructions. The mean flap coverage was 14.7 cm2. Complications occurred in 19.8% of cases, with venous congestion and partial flap necrosis occurring in 5.5 and 6.5% of cases, respectively, leading to a flap failure rate of 2.1%. Conclusion PPFs are a reliable option for hand or digital reconstruction, allowing surgeons to cover a variety of defects without sacrificing local vasculature. Despite nearly a 20% reported complication rate, nearly all flaps with venous congestion and partial flap necrosis included in these articles resolved without the need for secondary intervention, retaining an excellent overall flap survival.

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Treatment of Complex Soft-Tissue Defects at the Metacarpophalangeal Joint of the Thumb Using the Bilobed Second Dorsal Metacarpal Artery–Based Island Flap

Abstract: Therapeutic IV.

Cited by 8 publications

References 20 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

First Web-space Reconstruction Using the Second Dorsal Metacarpal Artery Cutaneous Flap: A Reliable Choice for Large Defects

Propeller Perforator Flaps Used for Hand and Digit Reconstruction: A Systematic Review

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