Objective To provide the anatomic bases for clinical application of the second dorsal metacarpal artery(SDMA) island flap with double pivot points. Methods The origin,branches and distribution of the recurrent cutaneous branch of the SDMA were observed in 30 adult fresh cadaver specimens, which were illustrated with special dye.Eighteen cases of skin defets of the thumb were repaired with the SDMA island flap. The defect locations were the dorsal part in 11 cases and palmar part in 7 cases, including 3 cases of defect in association with long pollical extensor defect and 2 cases of defect in association with dorsal skin defect of proximal finger. The flap area ranged from 2 cm×3 cmto 3 cm×5 cm. Results The appearance of therecurrent cutaneous branch of the SDMA was observed in all cases(100%), which originated 0.5±0.2 cm distant from the distal intersectiones between the SDMA and the index extensor and disappeared 1.2±0.5 cm distant from the proximal metacarpophalangeal joint. The branches of 1.7±0.7 were seen with a longitudinal fan-like distributionforward proximal part on the deep surface of the dorsal superficial vein. The exradius and the length of the recurrent cutaneous branch of the SDMA were 0.3±0.1 mm and 6.5±0.8 mm, respectively. The transplanted flaps survived in all cases and 16 cases were followed up for 8-14 months. The colour and appearance of the skin were satisfactory. The two-point discriminations were 0.9 mm in 3 cases by bridging digital nerve and 1.1 mm in 9 cases by anastomosing dorsal digital nerve; while the two-point discrimination was 13-15 mm in 4 cases without anastomosing nerve. Conclusion The origin,branches and distribution of the recurrent cutaneous branch of the SDMA is constant, which provide a potentially longer pedicle and increase the possibility to rotate the flap and also avoid the donor skin defect of rotation of the flap.
Objective To investigate the effectiveness of the perforator-based propeller flaps (PPFs) based on digital artery (DA) and dorsal metacarpal artery (DMA) in repairing hand wounds. Methods The clinical data of 45 patients with hand wounds between January 2018 and March 2023 were retrospectively analyzed. There were 27 males and 18 females with an average age of 41.2 years (range, 14-72 years). The causes of injury included twist injury in 15 cases, crush injury in 19 cases, and cut injury in 11 cases. The injured parts included 32 cases of digits, 10 cases of dorsal hand, and 3 cases of palmar hand, all of which had tendon, joint, and bone exposure. The time from injury to operation ranged from 2 to 8 hours (mean, 4.3 hours). The wound sizes after debridement ranged from 1.8 cm×1.0 cm to 5.0 cm×3.5 cm. Twenty-eight cases were repaired by the PPFs based on DA and 17 cases were repaired by the PPFs based on DMA. The flap size ranged from 2.5 cm×1.1 cm to 8.5 cm×4.0 cm. The defects of the donor sites in 14 patients were closed directly and the defects in the left 31 patients were resurfaced with free full-thickness skin graft from the proximal medial forearm.Results All the flaps survived after operation. Two cases of the PPF based on DA and 1 case of the PPF based on DMA underwent partially blisters at the distal end and healed after dressing change. The incisions in the donor site healed by first intention and the skin grafts survived. All patients were followed up 10-33 months, with a mean of 15.4 months. At last follow-up, the static two-point discrimination of the PPFs based on DA and DMA were 4-14 mm and 8-20 mm with the averages of 8.1 mm and 13.3 mm, respectively. According to the Michigan Hand Outcomes Questionnaire, 20 patients were very satisfied with the appearance of the PPF based on DA and 8 patients were satisfied; 8 patients were very satisfied with the appearance of the PPF based on DMA and 9 patients were satisfied. Based on the Vancouver Scar Scale (VSS), the appearance scores of the donor site of the PPFs based on DA and DMA were 2-7 and 4-9, with the averages of 4.2 and 6.1, respectively. ConclusionThe two kinds of PPFs are reliable in blood supply and easy to harvest, which provide a good method for emergency repair of small and medium area wounds in the hand.
The applied anatomy and clinical application were described in this paper. The blood supply of this flap was based on the second dorsal metacarpal artery. It gave some advantages of as easy of application, safe and reliable. Since November 1990, we had successfully used six such flaps in covering the soft tissue defects of the hand.
Objective To investigate the procedure and applications ofantegrade and retrograde dorsal metacarpal flaps with cutaneous branches as pedicles in repairing soft tissue defects of wrist and fingers. Methods From 1995 to 2003, we observed that the proximal and distal branches, deriving from the dorsal metacarpal artery, formed a consistent anastomosis arc subdermally. The anastomosis arc was paralleled to the dorsal metacarpal artery. Antegrade and retrograde dorsal metacarpal flaps could be designed using proximal anddistal branches as pedicles. Twenty-seven cases of soft tissue defects were treated by use of dorsal metacarpal flaps with cutaneous branches as pedicles, including 3 cases of defects on dorsum of hand with antegrade flaps, and 24 cases of defects on fingers with retrograde flaps ( index finger:12 cases; middle finger: 6 cases; ring finger: 4 cases; and little finger:2 cases). The dimensions of the antegrade flaps were 2.0 cm×4.0 cm～4.0 cm×6.0 cm, and the dimensions of theretrograde flaps were 2.5 cm×3.5 cm～3.0 cm×7.0 cm.The incision of the donor site was closed directly. Results All flaps survived. After a follow-up of 13 years, the texture and color of the flaps were good, and the shape and function of the donors were normal. Conclusion The antegrade or retrograde flap pedicled with the distal or proximal cutaneous branches of thedorsal metacarpal artery, is an optimal flap in repairing finger or wrist softtissue defects.
Objective To explore the effect of the first dorsal metacarpal artery-based pedicle dictyo-pattern sublobe flaps in repairing irregular wounds on thumbs and index fingers. Methods From December 2006 to March 2009, 15 patients with irregular wounds on thumbs and index fingers were treated, including 11 males and 4 femals, with an average age of 31 years (range, 18-48 years). Of them, 6 cases of hyperplastic scar of postburn had a 2-25 years course of disease (7.5 years onaverage) and 9 cases of machine injury had a 14-30 days course of disease (20 days on average). In 8 thumb wounds on palmaris, there were 3 cases of rhomboid wounds, 1 case of C-shape wound, and 4 cases of irregular wounds; the area of wounds ranged from 4.5 cm × 3.0 cm to 5.5 cm × 4.5 cm and wounds were treated by the first dorsal metacarpal artery-based proximate pedicle dictyo-pattern sublobe flaps (5 cm × 3 cm to 6 cm × 5 cm). In 7 index fingers wounds on dorsi-fingers, there were 3 cases of 2-wounds, 4 cases of irregular wounds; the area of wounds ranged from 1.0 cm × 0.5 cm to 2.2 cm × 2.0 cm and wounds were treated by the first dorsal metacarpal artery-based distal pedicle dictyo-pattern sublobe flaps (1.2 cm × 0.5 cm to 3.0 cm × 2.2 cm). The donor sites were covered with skin grafts or sutured directly. Results All of the flaps survived completely, the wound of recipient site healed at stage I. The free skin graft on donor site survived completely, the wound of donor site healed at stage I. All cases were followed up for 6-12 months (9 months on average). There was good appearance of flaps. The two point discrimination was 5-7 mm for the proximate pedicle flaps and 9-10 mm for the distal pedicle flaps. The thumbs had digital opposition, opposition function, the index fingers had no dysfunction. According to Hand Surgery Association Society of Chinese Medical Association Society standard for the part function evaluation trial-use of upper l imb, the results of the total active movement were excellent in 14 cases, and good in 1 case. The l ine-scar was existed at donor site of the case of direct suture, the function of thumb web had no dysfunction. Conclusion The first dorsal metacarpal artery-based pedicle dictyo-pattern sublobe flaps can repair the irregular wounds on thumbs and index fingers. It has rel iable blood supply and simple operation.
OBJECTIVE: To investigate the anatomic basis for transposition of the distal dorsal ulna bone flap pedicled with dorsal metacarpal artery to repair the defect of the 3rd or 4th and 5th metacarpal bone head. METHODS: In 30 adult cadaveric upper limbs, the branches and constitutions of the dorsal carpal arterial networks were observed. RESULTS: The dorsal carpal arterial networks were consisted of the dorsal carpal branches of ulnar and radial arteries, the terminal branches of posterior interosseous artery and the dorsal carpal branch of anterior interosseous artery, and then the 2nd, 3rd, 4th dorsal metacarpal branches were originated from the networks. The dorsal metacarpal branches were anastomosed with the deep branches of deep palmar arch to constitute the dorsal metacarpal artery. CONCLUSION: Transposition of the distal dorsal ulna bone flap pedicled with the 3rd, 4th dorsal metacarpal arteries can be used in repairing the defect of 3rd, 4th and 5th metacarpal bone head.