The second dorsal metacarpal artery flap relaying the dorsal island flap of the index finger for the repair of soft tissue defect of thumb_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WEI Zhenqiang ¹ , ZHAO Yi ¹ , WEI Haifeng ² , LIU Shenghe ² , SONG Jialin ² , CHEN Yuanyuan ² ,  RUAN Hongjiang ²

1. Department of Orthopedics, Sijing Hospital, Songjiang District of Shanghai, Shanghai, 201601, P. R. China;
2. Department of Orthopedics, Shanghai JiaoTong University Affillated Sixth People’s Hospital, Shanghai, 200233, P. R. China;

Corresponding author：

Keywords：

Skin and soft tissue defect; thumb; dorsal metacarpal artery flap; dorsal islanded flap of index finger; repair

DOI：

10.7507/1002-1892.202209052

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Objective To investigate the effectiveness of the second dorsal metacarpal artery fascial vascular pedicle retrograde island flap relaying the dorsal island flap of the index finger in repairing skin and soft tissue defects of the thumb. Methods The clinical data of 8 patients with skin and soft tissue defects of thumb between October 2019 and January 2021 were retrospectively analyzed. There were 3 males and 5 females with an average age of 35 years (range, 18-52 years). The causes of injury included machine injury in 2 cases, crush injury in 3 cases, and cutting injury in 3 cases. There were 2 cases of dorsal defect of the proximal part, 1 dorsal defect of the distal part, and 5 instances of the distal part defect. The skin and soft tissue defects ranged from 1.7 cm×1.4 cm to 3.0 cm×2.5 cm. The time from injury to flap repair was 7-21 days, with an average of 14 days. Firstly, the dorsal island flap of the index finger (dorsal side of the proximal part of the index finger) was used to repair the defect of the thumb. Then the second dorsal metacarpal artery fascia vascular pedicle retrograde island flap (near the radial side of the back of the hand) was used to repair the dorsal defect of the index finger; the donor site was sutured directly. Results Vascular crisis of the flap occurred in 1 case within 48 hours after operation, and the flap was bloated and bruised in 1 case due to excessive suture tension, and all the flaps survived after symptomatic treatment; partial skin margin of the flap was necrotic in 1 case after operation, and the incision healed after dressing change; the other 5 flaps survived, and all the wounds in the donor and recipient sites healed by first intention. All the 8 patients were followed up 3-10 months, with an average of 6 months. One patient had mild scar; the other patients had no significant difference in the color of the flap and the surrounding skin, no adhesion of tendons, and little interference of index finger function, and there was no obvious pain and dysfunction in the donor and recipient sites of the flap. At last follow-up, the extension-flexion range of motion of the metacarpophalangeal joint of the thumb was 0°-55°, and that of the interphalangeal joint was 0°-75°; the extension-flexion range of motion of the metacarpophalangeal joint of the index finger was 0°-82°, that of the proximal interphalangeal joints was 0°-90°, and that of the distal interphalangeral joints was 0°-65°. Conclusion The application of the second dorsal metacarpal artery fascial vascular pedicle retrograde island flap relaying the dorsal island flap of the index finger to repair skin and soft tissue defect wounds of thumb is a feasible treatment with reliable blood supply, less postoperative complications, no need for skin grafting, less interference to the function of the index finger, and satisfactory wound repair effect.

Citation： WEI Zhenqiang, ZHAO Yi, WEI Haifeng, LIU Shenghe, SONG Jialin, CHEN Yuanyuan, RUAN Hongjiang. The second dorsal metacarpal artery flap relaying the dorsal island flap of the index finger for the repair of soft tissue defect of thumb. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(1): 37-40. doi: 10.7507/1002-1892.202209052 Copy

1.	陈拓, 谢燕敏, 黄秀云. 改良示指背侧岛状皮瓣一期修复拇指末节缺损的效果评估. 中外医学研究, 2020, 18(27): 118-119.
2.	龙航, 徐佳丽, 王玉波, 等. 拇指桡侧指掌侧固有动脉穿支蒂第一掌骨桡背侧动脉皮瓣修复拇指软组织缺损. 中华手外科杂志, 2020, 36(5): 321-323.
3.	陈一, 王家辉, 江克罗. 静脉动脉化皮瓣修复拇指软组织缺损30例. 中华显微外科杂志, 2021, 44(1): 89-91.
4.	宋家林, 黄腾立, 高涛, 等. 游离腓动脉穿支皮瓣在足踝部软组织缺损中的临床应用. 中国修复重建外科杂志, 2021, 35(6): 756-760.
5.	冉小叶, 刘元波, 杨若梦, 等. 穿支螺旋桨皮瓣连续转移技术在下肢远端软组织缺损修复中的临床应用. 中国修复重建外科杂志, 2022, 36(4): 451-455.
6.	孙硕宁, 刘壮, 宋基学. 食指背侧岛状皮瓣修复拇指背侧大面积缺损. 中国伤残医学, 2020, 28(4): 47.
7.	施凯兵, 周振宇, 刘璠, 等. 掌背动脉逆行岛状皮瓣修复手指掌侧软组织缺损的感觉功能随访研究. 中华骨与关节外科杂志, 2020, 13(3): 210-213.
8.	Lin CH, Hsieh YH, Lin CH. The medial sural artery perforator flap in lower extremity reconstruction. Clin Plast Surg, 2021, 48(2): 249-257.
9.	荣向科, 石定, 刘刚义, 等. 两种逆行拇指背侧皮瓣修复拇指末节软组织缺损的对比研究. 中国骨与关节杂志, 2021, 10(12): 956-960.
10.	Karakol P, Sezgiç M, Tatar BE, et al. The use of dorsoradial forearm flap for the treatment of dorsal hand defect. J Surg Case Rep, 2020, 2020(7): rjaa153. doi: 10.1093/jscr/rjaa153.
11.	Couceiro J, de Prado M, Menendez G, et al. The first dorsal metacarpal artery flap family: A review. Surg J (N Y), 2018, 4(4): e215-e219.
12.	Yin Y, Tao X, Li Y, et al. Cosmetic and functional results of a newly reconstructed thumb by combining the phalanx of second toe and the great toenail flap transplantation. J Orthop Surg Res, 2020, 15(1): 458. doi: 10.1186/s13018-020-01986-y.
13.	Liu X, Sun Y, Jia Y, et al. Free extended posterior tibial artery perforator flap with the neurovascular plexus of a saphenous nerve branch for large soft tissue and sensory reconstruction: Anatomic study and clinical application. Microsurgery, 2021, 41(2): 133-139.
14.	王辉, 杨晓溪, 刘冰冰, 等. 手部三种近位带蒂皮瓣接力修复手指指端脱套伤及供区软组织缺损的效果. 中华烧伤杂志, 2021, 37(1): 64-69.

1. 陈拓, 谢燕敏, 黄秀云. 改良示指背侧岛状皮瓣一期修复拇指末节缺损的效果评估. 中外医学研究, 2020, 18(27): 118-119.
2. 龙航, 徐佳丽, 王玉波, 等. 拇指桡侧指掌侧固有动脉穿支蒂第一掌骨桡背侧动脉皮瓣修复拇指软组织缺损. 中华手外科杂志, 2020, 36(5): 321-323.
3. 陈一, 王家辉, 江克罗. 静脉动脉化皮瓣修复拇指软组织缺损30例. 中华显微外科杂志, 2021, 44(1): 89-91.
4. 宋家林, 黄腾立, 高涛, 等. 游离腓动脉穿支皮瓣在足踝部软组织缺损中的临床应用. 中国修复重建外科杂志, 2021, 35(6): 756-760.
5. 冉小叶, 刘元波, 杨若梦, 等. 穿支螺旋桨皮瓣连续转移技术在下肢远端软组织缺损修复中的临床应用. 中国修复重建外科杂志, 2022, 36(4): 451-455.
6. 孙硕宁, 刘壮, 宋基学. 食指背侧岛状皮瓣修复拇指背侧大面积缺损. 中国伤残医学, 2020, 28(4): 47.
7. 施凯兵, 周振宇, 刘璠, 等. 掌背动脉逆行岛状皮瓣修复手指掌侧软组织缺损的感觉功能随访研究. 中华骨与关节外科杂志, 2020, 13(3): 210-213.
8. Lin CH, Hsieh YH, Lin CH. The medial sural artery perforator flap in lower extremity reconstruction. Clin Plast Surg, 2021, 48(2): 249-257.
9. 荣向科, 石定, 刘刚义, 等. 两种逆行拇指背侧皮瓣修复拇指末节软组织缺损的对比研究. 中国骨与关节杂志, 2021, 10(12): 956-960.
10. Karakol P, Sezgiç M, Tatar BE, et al. The use of dorsoradial forearm flap for the treatment of dorsal hand defect. J Surg Case Rep, 2020, 2020(7): rjaa153. doi: 10.1093/jscr/rjaa153.
11. Couceiro J, de Prado M, Menendez G, et al. The first dorsal metacarpal artery flap family: A review. Surg J (N Y), 2018, 4(4): e215-e219.
12. Yin Y, Tao X, Li Y, et al. Cosmetic and functional results of a newly reconstructed thumb by combining the phalanx of second toe and the great toenail flap transplantation. J Orthop Surg Res, 2020, 15(1): 458. doi: 10.1186/s13018-020-01986-y.
13. Liu X, Sun Y, Jia Y, et al. Free extended posterior tibial artery perforator flap with the neurovascular plexus of a saphenous nerve branch for large soft tissue and sensory reconstruction: Anatomic study and clinical application. Microsurgery, 2021, 41(2): 133-139.
14. 王辉, 杨晓溪, 刘冰冰, 等. 手部三种近位带蒂皮瓣接力修复手指指端脱套伤及供区软组织缺损的效果. 中华烧伤杂志, 2021, 37(1): 64-69.

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Chinese Journal of Reparative and Reconstructive Surgery

The second dorsal metacarpal artery flap relaying the dorsal island flap of the index finger for the repair of soft tissue defect of thumb

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