Reverse Dorsal Metacarpal Artery Flap: Its Clinical Use And Outcome In Reconstruction Of Soft Tissue Defect Of Fingers

ObjectiveTo study the use of reverse dorsal metacarpal artery flap in reconstruction of finger softtissue defect and its surgical outcome. Uses and evaluation of various types of DMA flap inreconstruction of both dorsal and volar surface of fingers.Materials and methodsFrom January2011till January2013, total21cases of finger injuries underwent dorsalmetacarpal artery perforator flap surgery. These cases were collected from the department ofhand surgery. Their name, age, sex, etiology of injury, type of surgery, condition of wound,total number of surgeries, surgical outcome, complications, follow up and total hospital staywere recorded. Most patients were labor manual workers followed by farmers, in both cases amachinery trauma was the common source of finger trauma. Only one out of21total patientswas female. The age ranged from3years to67years (mean age of35years). The etiologiesof finger tissue defects were mostly machinery avulsions, crush injuries and others wereinfections and post injury contractures. All the cases underwent reverse dorsal metacarpalartery flap surgery. Most of the cases were referred from other hospitals and requireddebridement prior to flap surgery. The flap sizes were variable, the largest being8cmX3cmand the smallest being2.5cmX1.2cm. Average flap size was5.4cmX2.4cm size. Compositereverse dorsal metacarpal artery flap was used in five cases. RDMA flap composed of tendon,was used in five cases including a case of FDP tendon injury of middle finger with tissuedefect, both the tendon and dorsal sensory nerve was carried in a composite flap.2ndRDMAflap was performed in eleven cases,3rdand4thDMA perforator in five cases each. Out of21cases11cases were dorsal tissue defect of fingers and rest10being the volar side. For thefirst24hours, qualified nursing staff postoperatively monitored all the flaps for the skin color,turgor, capillary refill and temperature of flap.ResultsOut of21, nineteen flaps survived completely. One case had partial distal edge necrosis.In one case, even if the flap survived completely, the finger had to be amputed because ofuncontrolled infection. Two cases had venous congestion in early postoperative period, whichwas managed by bleeding from the flap. This later subsided and the flap survived completelywithout any further complications. Patients follow up period ranged from1month to24months.Early mobilization of fingers was started except in complicated cases of fractures and tendon injuries. Exercises were carried out immediately after stitches were removed reducingthe chance of joint stiffness and early return to work. The average hospital stay was around12days. The outcome was satisfactory with complete healing; good aesthetic match for thedorsum and satisfactory match for the volar skin was achieved. The two-point discriminationfor sensation of a neurocutaneous RDMA was10mm. There was no such differencecompared to10mm to12mm2PD in other non neurocutaneous RMDA. The fingers hadsatisfactory functional outcome with good range of motion. The donor site scar wasaesthetically acceptable; all of the flaps were closed primarily without the need of skingrafting.ConclusionThe reverse dorsal metacarpal artery flap is one of the reliable and near source forcovering tissue defect of dorsal and volar surface of fingers. This flap can be used as acomposite flap to carry interosseous muscle, extensor tendon, dorsal sensory nerve or a pieceof metacarpal bone when needed. Overall, it provides perfect color match for dorsum offingers as well as satisfactory color match for volar skin with single stage operation andprimary and primary closure of the donor site.