Poster
# 114
Poster |
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6th Internet World Congress for Biomedical Sciences |
Alejandro Nogueira(1), Olatz Alcelay(2), MŞ Jesús Martínez González(3), Angel Perez Arias(4), Francisco Iglesias(5)
(1)(2)(3)(4)(5)Hospital Central de Asturias - Oviedo. Spain
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[Orthopedics & Traumatology] |
[Plastic Surgery] |
Dorsal metacarpal arteries arises from carpal arch(a branch from the radial artery to the dorsal carpal branch of the ulnar artery), except for the first space one which is a direct branch from the radial artery at the first web. They run in the depth of the interosseous space of the dorsal hand, vascularizing dorsal skin. The 1st and the 2 nd branches are constant, but the 3 rd and 4th dorsal metacarpal arteries may be atrophic or absent, especially the later (1,2).
We have operated 6 patients with dorsal defects of index and middle fingers, using flaps based 1st and 2nd metacarpal arteries:
-A patient with skins neoplasies at dorsum of the second phalanx of the middle finger that go through the extensor tendon. We made excision, tendon plastia and reconstruction with 2,5x5 cm flap based on the 2nd metacarpal arteries.(fig.1,fig2).
-A rheumatic patients with skin necrosis caused by radioactive Itrium at dorsum of PIP joint on the index with tendinoous exposition. We made debridement and we covered with 2.5x2.5 cm flap based on the 1st metacarpal artery. (fig. 3, fig4).
-Two patients with traumatic skin, tendineous and joint defect at dorsum of PIP joint of the index. PIP artrodesisand reconstruction with 2.5x5 cm flap based on the 1st metacarpal artery was performed. (fig. 5, fig6).
-Two patients with traumatic skin and tendineous defect at dorsum of tha 2nd phalanx of the middle finger . We covered the defect with 2.5x 5 cm flap based on th 2nd metacarpal artery(fig. 7).
Traumatic defects and skin necrosis have been satisfactorily reconstructed with flaps up to 5x2.5 cm size based on the 1st and 2nd metacarpal arteries. The distal limit of reach is a DIP joint. All the flaps we used survive enterily. Donor site were closed primarily at the dorsum at the hand, but large flaps at the 1 st web required skin graft in order to avoid functional retraction. The mobility and the function of the fingers are good.(fig 8, fig 9,fig 10,fig11, fig 12).
We consider the reverse flow dorsal metacarpal flaps as an extremely usefull flap. The dorsalmetacarpal arteries present two distal anastomosis with the volar vascular system; the first at the neck of metacarpal and another one at the base of proximal phalanges; with one of this pivot points, the sin of the dorsum of the hand can be transferred to distal areas of the fingers.
We consider this flap the best alternative to the classic techniques used to cover those defects like the cross-finger flap; the need for prolonged immobilisation period of the digits in awkward positions is eliminated so the incidence of permanent stiffness is reduced, the reconstruction is performed in one stage , total skin closure is achieved immediately so the risk of infection decreasas and as o composite tissue transfer they allow the simultaneous transfer of bone, joints and nerves graft (3,4).
The reverse dorsal metacarpal islands flaps provide ideal and reliable coverage of the dorsum of the PIP and medium phalanx of the index and medium fingers often with primary closure of the donor site.
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[Orthopedics & Traumatology] |
[Plastic Surgery] |
