Alejandro Nogueira⁽¹⁾, Mª Jesús Martínez González⁽²⁾, Olatz Alcelay⁽³⁾, Francisco Iglesias⁽⁴⁾, Teresa Pérez ^{(5)
(1)(2)(3)(4)(5)}Hospital Central de Asturias - Oviedo. Spain

	[Orthopedics & Traumatology]
		[Plastic Surgery]

INTRODUCTION

First dorsal metacarpal artery flap, developed by Holevitch and Foucher, is based in an arteriovenous system rising from the radial artery at the first web. It is a constant branch that is accompanied by sensitive branches from the radial nerve and superficial veins. Supplies the skin of the dorsum of the hand and the proximal phalanx of index finger ( part of the middle one as well).With a direct flow design and skin island on the dorsum of the proximal phalanx of index finger is one of the most useful flaps for thum reconstruction ⁽¹⁾. We present ten cases.

MATERIAL & METHODS

We have operated ten patients with thum defects that have been reconstructed with this flap. Indications have been dorsal or dorsolateral defects and etiology was: traumatic skin defects, tumours, amputation stumps, subtotal avulsions and tenoplasties or arthrodesis under skindefects. We have also used the flap in one case to resurface the volar aspect as an alternative to Littler, Brunelli or free toe transfer flaps in non-dominant hands, with neurorraphy between radial nerve branches and

Figure 1: Pre and Post-op in case 1.

Figure 2: Pre and Post-op in case 2.

Figure 3: Pre and Post-op in case 3.

RESULTS

All but one ( the first developed partial necrosis, due to lack of experience) flaps survived. Deep structures reconstructed healed well, and quality of skin transferred was excellent. Donor site, covered with full or split-thickness graft, is usually uneventful, but in patients over 50 yr may lead to some degree of MCP loss motion.

DISCUSSION

The kite flap is a good method for reconstruction of defects of the thumb in its dorsum aspect. Littler flap presents more difficult disection with hight morbidity and important sequels. Other alternatives ( toe transfer, cross-finger) offers the same poblems. For the volar aspect the option is more discuted becuase discriminatory sensibility is poor although neurorraphy it was carried out. In these cases Littler or other island flaps will be used ⁽²⁾, ⁽³⁾.

CONCLUSIONS

This flap is an alternative to reconstruction of the thumb dorsum with excellent functional and cosmetic results. For the volar aspect supplies suboptimal functional results.

BIBLIOGRAPHY

Dautel G, Merle M, Borrely J: Variations anatomiques du rèseau vasculaire de la 1ª commissure dorsale. Application au lambeau cerf volant. Ann Chir. Mai,8,53-5
Earley MS: The arterial supply of the thum, first web and index finger and its surgical application. J. Hand Surg,11B,2,1986.
Foucher G, Braun JB: A new island flap in surgery of the hand. Plastic Reconstr. Surg, 63,28-31,1979.

Discussion Board

Any Comment to this presentation?

[ABSTRACT] [INTRODUCTION] [MATERIAL & METHODS] [RESULTS] [IMAGES] [IMAGES-2] [IMAGES-3] [IMAGES-4] [DISCUSSION] [CONCLUSIONS] [BIBLIOGRAPHY] [Discussion Board]

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	[Orthopedics & Traumatology]
		[Plastic Surgery]

Alejandro Nogueira, Mª Jesús Martínez González, Olatz Alcelay, Francisco Iglesias, Teresa Pérez
Copyright © 1999-2000. All rights reserved.

Last update: 15/01/00