Narrow Results

The first dorsal metacarpal artery flap was initially described by Hilgenfeldt, it was designed as a racquet flap by Holevich and modified as an island flap by Foucher and Braun. The objective of the present is to compare the Holevich flap and the Foucher flap in terms of venous congestion and flap necrosis.

From 2009 to 2013, ten first dorsal metacarpal artery flaps were performed at our hospital's hand unit. Five of the flaps were Holevich type flaps and five of the flaps were Foucher flaps. There were seven men and three women. The mean age was 47 years for the Foucher flap group (17–67 years), and 48 years for the Holevich flap group (36–61 years).

Strength, static two tips discrimination, ranges of motion, satisfaction, cold intolerance, pain, flap congestion and flap necrosis were recorded for both groups.

Similar values of strength, pain, range of motion and two tips discrimination were found on both groups. There was a higher incidence of flap congestion and necrosis on the Foucher flap group (two thumbs underwent partial flap necrosis and two underwent venous congestion in three patients). There was also a higher incidence of cold intolerance in the Foucher group (two patients exhibited moderate cold intolerance and one exhibited a severe cold intolerance). A proper statistical analysis was not possible due to the size of the case series.

In this small case series the Holevich exhibited less flap necrosis, less venous congestion, and less incidence of cold intolerance than the Foucher flap.

The treatment of extensive soft tissue defects in the thumb with dorsal metacarpal artery flaps has been previously reported in the literature. Island flaps from the dorsum of the index and long fingers have been the subject of many reports and studies. However, when the defect involves the whole thumb, a 360° circumferential defect, standard first or second dorsal metacarpal artery flaps are usually insufficient. There are fewer reports on the use of bilobed flaps for this application and we have found no reports on the use of bilobed racquet flaps or extended seagull flaps as treatment for this condition. We report the salvage of a thumb degloving injury with use of a bilobed racquet flap.

Background: The thumb plays an important role in the function of the hand. Sensate reconstruction of the pulp is important in restoring function to the thumb. The aim of this study is to present outcomes of a sensate islanded first dorsal metacarpal artery (FDMA) flap used for the reconstruction of skin defects of the thumb.

Methods: Patients who had a FDMA flap reconstruction of thumb pulp defects in the orthopaedics and traumatology clinic of affiliated hospital were included in the study. This included eight thumbs of eight patients. The range of motion, sensation and cosmetic satisfaction in the donor and recipient areas were evaluated at a minimum of 2-year follow-up.

Results: There were no partial or complete flap failures. The mean static 2-point discrimination was 15 mm and the mean Semmes–Weinstein monofilament test score was 3.93. Cortical re-orientation was observed in 65% of patients. Near normal range of motion and Kapandji scores were regained in all patients.

Conclusions: Excellent motion and sensory outcomes were obtained following the FDMA flap reconstruction of thumb pulp defects. The donor morbidity of the flap is minimal, and this flap can be considered as one of the primary options for reconstruction of thumb pulp defects.

Level of Evidence: Level V (Therapeutic)