Sensate first dorsal metacarpal artery flap for resurfacing extensive pulp defects of the thumb

TY - JOUR

T1 - Sensate first dorsal metacarpal artery flap for resurfacing extensive pulp defects of the thumb

AU - Chang, Shun-Cheng

AU - Chen, Shao-Liang

AU - Chen, Tim-Mo

AU - Chuang, Chia-Jueng

AU - Cheng, Tian-Yeu

AU - Wang, Hsian-Jenn

N1 - 被引用次數：26 Export Date: 21 March 2016 CODEN: APCSD 通訊地址: Chen, S.-L.; Division of Plastic Surgery, Tri-Service General Hospital, Yung-Chun Street, Taipei 100, Taiwan; 電子郵件： shaoliang1025@hotmail.com 參考文獻: Argamazo, R.V., Rotation/transposition method for the soft tissue replacement on the distal segment of the thumb (1974) Plast Reconstr Surg, 19, pp. 37-40; Gaul, J.S., Radial-innervated cross-finger flap from index to provide sensory pulp to injured thumb (1969) J Bone Joint Surg, 51 A, pp. 1257-1263; Littler, J.W., The neurovascular pedicle method of digital transposition for reconstruction of the hand (1953) Plast Reconstr Surg, 12, pp. 303-319; El-Gammal, T.A., Wei, F.C., Microvascular reconstruction of the distal digits by partial toe transfer (1997) Clin Plast Surg, 24, pp. 49-55; Foucher, G., Braun, J.B., A new island flap transfer from the dorsum of the index to the thumb (1979) Plast Reconstr Surg, 63, pp. 344-349; Rybka, F.J., Pratt, F.E., Thumb reconstruction with a sensory flap from the dorsum of the index finger (1979) Plast Reconstr Surg, 64, pp. 141-144; Earley, M.G., Milner, R.H., Dorsal metacarpal flaps (1987) Br J Plast Surg, 40, pp. 333-341; Small, J.O., Brennen, M.D., The first metacarpal artery neurovascular island flap (1988) J Hand Surg, 13 B, pp. 136-145; Yang, J.Y., The first dorsal metacarpal flap in first web space and thumb reconstruction (1991) Ann Plast Surg, 27, pp. 258-264; Earley, M.J., The arterial supply of the thumb, first web and index finger and its surgical application (1986) J Hand Surg, 11 B, pp. 163-174; Sherif, M.M., First dorsal metacarpal artery flap in hand reconstruction, I: Anatomy study (1994) J Hand Surg, 19 A, pp. 26-31; Sherif, M.M., First dorsal metacarpal artery flap in hand reconstruction, II: Clinical application (1994) J Hand Surg, 19 A, pp. 32-38; Tubiana, R., Duparc, J., Restoration of sensibility in the hand by neurovascular skin island transfer (1961) J Bone Joint Surg, 43 B, pp. 474-480; Ratcliffe, R.J., Regan, P.J., Scerri, G.V., First dorsal metacarpal artery flap cover for extensive pulp defects in the normal length thumb (1992) Br J Plast Surg, 45, pp. 544-546; El-Khatib, H.A., Clinical experiences with the extended first dorsal metacarpal artery island flap for thumb reconstruction (1998) J Hand Surg, 23 A, pp. 647-652; Gebhard, B., Meissl, G., An extended first dorsal metacarpal artery neurovascular island flap (1995) J Hand Surg, 10 B, pp. 529-531

PY - 2004

Y1 - 2004

N2 - Finding an appropriate soft-tissue grafting material to close a wound located over the distal phalanx of the thumb, especially the pulp region, can be a difficult task. A sensate first dorsal metacarpal artery flap, mobilized from the dorsum of the adjacent index finger and used as an island pedicle skin flap, can be useful for this purpose. The pedicle includes the ulnar branch of the first dorsal metacarpal artery, the dorsal veins, and the cutaneous branch of the radial nerve. Although this tiny artery is anatomically variable, safe dissection can be achieved by including the radial shaft periosteum of the secondary metacarpal bone and the ulnar head fascia of the first interosseous muscle. This approach has been used for 8 individuals with extensive pulp defects of the thumb over the past 3 years. Skin defects in all patients were combined with bone, joint, or tendon exposure. All flaps survived completely. This 1-stage procedure is reliable and technically simple. It provides sensate coverage to the pulp of the thumb but also avoids nerve repair or more complicated microsurgery.

AB - Finding an appropriate soft-tissue grafting material to close a wound located over the distal phalanx of the thumb, especially the pulp region, can be a difficult task. A sensate first dorsal metacarpal artery flap, mobilized from the dorsum of the adjacent index finger and used as an island pedicle skin flap, can be useful for this purpose. The pedicle includes the ulnar branch of the first dorsal metacarpal artery, the dorsal veins, and the cutaneous branch of the radial nerve. Although this tiny artery is anatomically variable, safe dissection can be achieved by including the radial shaft periosteum of the secondary metacarpal bone and the ulnar head fascia of the first interosseous muscle. This approach has been used for 8 individuals with extensive pulp defects of the thumb over the past 3 years. Skin defects in all patients were combined with bone, joint, or tendon exposure. All flaps survived completely. This 1-stage procedure is reliable and technically simple. It provides sensate coverage to the pulp of the thumb but also avoids nerve repair or more complicated microsurgery.

KW - First dorsal metacarpal artery flap

KW - Pulp defect of thumb

KW - adult

KW - anatomy

KW - artery

KW - article

KW - clinical article

KW - dissection

KW - dorsal vein

KW - female

KW - first dorsal metacarpal artery

KW - first dorsal metacarpal artery flap

KW - graft survival

KW - human

KW - male

KW - pedicled skin flap

KW - periosteum

KW - phalanx

KW - priority journal

KW - radial nerve

KW - skin defect

KW - skin graft

KW - surgical technique

KW - thumb malformation

KW - vein

KW - wound closure

KW - Adult

KW - Arteries

KW - Female

KW - Fingers

KW - Humans

KW - Male

KW - Metacarpus

KW - Middle Aged

KW - Soft Tissue Injuries

KW - Surgical Flaps

KW - Thumb

U2 - 10.1097/01.sap.0000137134.15728.dd

DO - 10.1097/01.sap.0000137134.15728.dd

M3 - Article

VL - 53

SP - 449

EP - 454

JO - Annals of Plastic Surgery

JF - Annals of Plastic Surgery

SN - 0148-7043

IS - 5

ER -