Repairing large skin defect of hand with modified dorsal metacarpal artery reverse island flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANG Hui , HUO Yongxin , WANG Hongtao , JIA Xinwei , ZHANG Yihan

Department of Hand Surgery, Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China;

Corresponding author：

WANG Hui, Email: wanghuiyxx@163.com

Keywords：

Dorsal metacarpal artery flap; skin defect of hand; wound repair

DOI：

10.7507/1002-1892.202204131

Video：

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Objective To investigate the effectiveness of modified dorsal metacarpal artery reverse island flap based on two adjacent recurrent branches of dorsal metacarpal arteries in repairing large skin defect of the hand. Methods Between September 2017 and March 2021, 15 cases of large skin defect of the hand were treated. There were 11 males and 4 females with an average age of 42 years (range, 24-66 years). The injury causes included machine twist injury in 6 cases, pound injury in 5 cases, and crush injury in 4 cases. The injured parts included 6 cases of finger skin defect and 9 cases of distal skin defect of palm and dorsum of hand, all of which had tendon, joint, and bone exposure. The interval from injury to operation ranged from 2 to 6 hours (mean, 4 hours). The defect sizes after thorough debridement ranged from 3.5 cm×3.0 cm to 8.0 cm×4.5 cm. The modified dorsal metacarpal artery reverse island flap with a range of 3.8 cm×3.3 cm to 9.0 cm×5.0 cm was used to repair the defect, and the flap donor site was repaired with full-thickness skin graft. Results All the flaps survived successfully after operation, and the wounds in the recipient site and the skin grafts in the donor site healed by first intention. All patients were followed up 9-24 months, with an average of 14 months. The appearance of the flap was good, and its texture and color were similar to those of the surrounding normal tissue. There was no obvious scar contracture, depression, and pigmentation in the donor site. At last follow-up, the static two-point discrimination of the flap was 8-20 mm, with an average of 13.6 mm. According to the Michigan Hand Outcome Questionnaire, 5 patients were very satisfied with the appearance of the flap, and 10 patients were satisfied. Conclusion The modified dorsal metacarpal artery reverse island flap based on two adjacent recurrent branches of dorsal metacarpal arteries has reliable blood supply, larger harvested area, simple procedure, and minimal donor site damage, which is suitable for emergency repair of large skin defect of the hand.

Citation： WANG Hui, HUO Yongxin, WANG Hongtao, JIA Xinwei, ZHANG Yihan. Repairing large skin defect of hand with modified dorsal metacarpal artery reverse island flap. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(10): 1273-1276. doi: 10.7507/1002-1892.202204131 Copy

1.	路来金, 姜永冲, 张巨, 等. 手背逆行岛状皮瓣的临床应用. 中华外科杂志, 1991, 29(10): 593-595.
2.	Balan JR, Mathew S, Kumar P, et al. The reverse dorsal metacarpal artery flap in finger reconstruction: A reliable choice. Indian J Plast Surg, 2018, 51(1): 54-59.
3.	Bordianu A, Leoveanu FI. Hand soft tissue reconstruction with dorsal metacarpal artery perforator (Quaba) flap. J Med Life, 2021, 14(5): 731-736.
4.	王培吉, 赵家举, 张勇. 掌背动脉穿支蒂逆行筋膜皮瓣与蒂部微型瓣的设计与应用. 中华手外科杂志, 2013, 29(4): 212-214.
5.	王扬剑, 陈林海, 郑雪红, 等. 掌背动脉背侧皮支皮瓣修复手指中末节软组织缺损. 中华显微外科杂志, 2018, 41(3): 213-215.
6.	Chung KC, Pillsbury MS, Walters MR, et al. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg (Am), 1998, 23(4): 575-587.
7.	Zhao F. Flap repair technique for soft tissue defects of the hand. Ann Plast Surg, 2021, 86(3S Suppl 2): S319-S321.
8.	Seo BF, Kwon BY, Han HH. Sensate hypothenar perforator free flap for resurfacing large volar surface defect of the digit. Microsurgery, 2018, 38(4): 419-422.
9.	于春波, 刘鹏, 梁亚闯, 等. 第2掌背动脉-指背动脉蒂双叶微皮瓣的应用解剖. 中华显微外科杂志, 2019, 42(6): 562-565.
10.	Das De S, Sebastin SJ. Soft tissue coverage of the digits and hand. Hand Clin, 2020, 36(1): 97-105.
11.	胡玉庆, 宋利华, 马天骁, 等. 带部分尺侧腕屈肌腱的尺动脉腕上皮支皮瓣修复手部复合组织缺损. 中华手外科杂志, 2020, 36(5): 386-387.
12.	钟少开, 李培, 凌利, 等. 桡动脉穿支皮瓣修复手部皮肤缺损的临床应用. 中华手外科杂志, 2019, 35(6): 422-424.
13.	孙从府, 房巍, 王增涛, 等. 手及前臂巨大皮肤缺损两种皮瓣修复的方法和讨论. 中国矫形外科杂志, 2019, 27(10): 954-955.
14.	陈垒垒, 王诒焓, 郭松雪, 等. 腹部带蒂超薄皮瓣一期分指修复多指复合组织缺损. 实用手外科杂志, 2022, 36(1): 77-79.
15.	Ono S, Sebastin SJ, Ohi H, et al. Microsurgical flaps in repair and reconstruction of the hand. Hand Clin, 2017, 33(3): 425-441.
16.	欧昌良, 周鑫, 陈孝均, 等. 游离足底内侧动脉皮瓣修复手掌部软组织缺损. 中华显微外科杂志, 2021, 44(3): 310-312.
17.	Wang Y, Wu T, Lu S, et al. Medial plantar venous flap: Classic donor site modification for hand defects. Ann Plast Surg, 2018, 81(4): 444-448.
18.	Wang L, Liu H, Ma T, et al. Reconstruction of soft tissue defects in the hand with a free anterolateral thigh deep fascia flap. Orthop Surg, 2021, 13(3): 758-767.
19.	郑大伟, 朱辉, 陈步国, 等. 健康成人四肢两点分辨觉的测定. 中华医学杂志, 2018, 98(39): 3212-3214.

1. 路来金, 姜永冲, 张巨, 等. 手背逆行岛状皮瓣的临床应用. 中华外科杂志, 1991, 29(10): 593-595.
2. Balan JR, Mathew S, Kumar P, et al. The reverse dorsal metacarpal artery flap in finger reconstruction: A reliable choice. Indian J Plast Surg, 2018, 51(1): 54-59.
3. Bordianu A, Leoveanu FI. Hand soft tissue reconstruction with dorsal metacarpal artery perforator (Quaba) flap. J Med Life, 2021, 14(5): 731-736.
4. 王培吉, 赵家举, 张勇. 掌背动脉穿支蒂逆行筋膜皮瓣与蒂部微型瓣的设计与应用. 中华手外科杂志, 2013, 29(4): 212-214.
5. 王扬剑, 陈林海, 郑雪红, 等. 掌背动脉背侧皮支皮瓣修复手指中末节软组织缺损. 中华显微外科杂志, 2018, 41(3): 213-215.
6. Chung KC, Pillsbury MS, Walters MR, et al. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg (Am), 1998, 23(4): 575-587.
7. Zhao F. Flap repair technique for soft tissue defects of the hand. Ann Plast Surg, 2021, 86(3S Suppl 2): S319-S321.
8. Seo BF, Kwon BY, Han HH. Sensate hypothenar perforator free flap for resurfacing large volar surface defect of the digit. Microsurgery, 2018, 38(4): 419-422.
9. 于春波, 刘鹏, 梁亚闯, 等. 第2掌背动脉-指背动脉蒂双叶微皮瓣的应用解剖. 中华显微外科杂志, 2019, 42(6): 562-565.
10. Das De S, Sebastin SJ. Soft tissue coverage of the digits and hand. Hand Clin, 2020, 36(1): 97-105.
11. 胡玉庆, 宋利华, 马天骁, 等. 带部分尺侧腕屈肌腱的尺动脉腕上皮支皮瓣修复手部复合组织缺损. 中华手外科杂志, 2020, 36(5): 386-387.
12. 钟少开, 李培, 凌利, 等. 桡动脉穿支皮瓣修复手部皮肤缺损的临床应用. 中华手外科杂志, 2019, 35(6): 422-424.
13. 孙从府, 房巍, 王增涛, 等. 手及前臂巨大皮肤缺损两种皮瓣修复的方法和讨论. 中国矫形外科杂志, 2019, 27(10): 954-955.
14. 陈垒垒, 王诒焓, 郭松雪, 等. 腹部带蒂超薄皮瓣一期分指修复多指复合组织缺损. 实用手外科杂志, 2022, 36(1): 77-79.
15. Ono S, Sebastin SJ, Ohi H, et al. Microsurgical flaps in repair and reconstruction of the hand. Hand Clin, 2017, 33(3): 425-441.
16. 欧昌良, 周鑫, 陈孝均, 等. 游离足底内侧动脉皮瓣修复手掌部软组织缺损. 中华显微外科杂志, 2021, 44(3): 310-312.
17. Wang Y, Wu T, Lu S, et al. Medial plantar venous flap: Classic donor site modification for hand defects. Ann Plast Surg, 2018, 81(4): 444-448.
18. Wang L, Liu H, Ma T, et al. Reconstruction of soft tissue defects in the hand with a free anterolateral thigh deep fascia flap. Orthop Surg, 2021, 13(3): 758-767.
19. 郑大伟, 朱辉, 陈步国, 等. 健康成人四肢两点分辨觉的测定. 中华医学杂志, 2018, 98(39): 3212-3214.

Chinese Journal of Reparative and Reconstructive Surgery

Repairing large skin defect of hand with modified dorsal metacarpal artery reverse island flap

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