Repairing large skin defect of hand with modified dorsal metacarpal artery reverse island flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANG Hui , HUO Yongxin , WANG Hongtao , JIA Xinwei , ZHANG Yihan

Department of Hand Surgery, Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China;

Corresponding?author：

WANG Hui, Email: wanghuiyxx@163.com

Keywords：

Dorsal metacarpal artery flap; skin defect of hand; wound repair

DOI：

10.7507/1002-1892.202204131

Video：

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Objective To investigate the effectiveness of modified dorsal metacarpal artery reverse island flap based on two adjacent recurrent branches of dorsal metacarpal arteries in repairing large skin defect of the hand. Methods Between September 2017 and March 2021, 15 cases of large skin defect of the hand were treated. There were 11 males and 4 females with an average age of 42 years (range, 24-66 years). The injury causes included machine twist injury in 6 cases, pound injury in 5 cases, and crush injury in 4 cases. The injured parts included 6 cases of finger skin defect and 9 cases of distal skin defect of palm and dorsum of hand, all of which had tendon, joint, and bone exposure. The interval from injury to operation ranged from 2 to 6 hours (mean, 4 hours). The defect sizes after thorough debridement ranged from 3.5 cm×3.0 cm to 8.0 cm×4.5 cm. The modified dorsal metacarpal artery reverse island flap with a range of 3.8 cm×3.3 cm to 9.0 cm×5.0 cm was used to repair the defect, and the flap donor site was repaired with full-thickness skin graft. Results All the flaps survived successfully after operation, and the wounds in the recipient site and the skin grafts in the donor site healed by first intention. All patients were followed up 9-24 months, with an average of 14 months. The appearance of the flap was good, and its texture and color were similar to those of the surrounding normal tissue. There was no obvious scar contracture, depression, and pigmentation in the donor site. At last follow-up, the static two-point discrimination of the flap was 8-20 mm, with an average of 13.6 mm. According to the Michigan Hand Outcome Questionnaire, 5 patients were very satisfied with the appearance of the flap, and 10 patients were satisfied. Conclusion The modified dorsal metacarpal artery reverse island flap based on two adjacent recurrent branches of dorsal metacarpal arteries has reliable blood supply, larger harvested area, simple procedure, and minimal donor site damage, which is suitable for emergency repair of large skin defect of the hand.

Citation： WANG Hui, HUO Yongxin, WANG Hongtao, JIA Xinwei, ZHANG Yihan. Repairing large skin defect of hand with modified dorsal metacarpal artery reverse island flap. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(10): 1273-1276. doi: 10.7507/1002-1892.202204131 Copy

1.	路來金, 姜永沖, 張巨, 等. 手背逆行島狀皮瓣的臨床應用. 中華外科雜志, 1991, 29(10): 593-595.
2.	Balan JR, Mathew S, Kumar P, et al. The reverse dorsal metacarpal artery flap in finger reconstruction: A reliable choice. Indian J Plast Surg, 2018, 51(1): 54-59.
3.	Bordianu A, Leoveanu FI. Hand soft tissue reconstruction with dorsal metacarpal artery perforator (Quaba) flap. J Med Life, 2021, 14(5): 731-736.
4.	王培吉, 趙家舉, 張勇. 掌背動脈穿支蒂逆行筋膜皮瓣與蒂部微型瓣的設計與應用. 中華手外科雜志, 2013, 29(4): 212-214.
5.	王揚劍, 陳林海, 鄭雪紅, 等. 掌背動脈背側皮支皮瓣修復手指中末節軟組織缺損. 中華顯微外科雜志, 2018, 41(3): 213-215.
6.	Chung KC, Pillsbury MS, Walters MR, et al. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg (Am), 1998, 23(4): 575-587.
7.	Zhao F. Flap repair technique for soft tissue defects of the hand. Ann Plast Surg, 2021, 86(3S Suppl 2): S319-S321.
8.	Seo BF, Kwon BY, Han HH. Sensate hypothenar perforator free flap for resurfacing large volar surface defect of the digit. Microsurgery, 2018, 38(4): 419-422.
9.	于春波, 劉鵬, 梁亞闖, 等. 第2掌背動脈-指背動脈蒂雙葉微皮瓣的應用解剖. 中華顯微外科雜志, 2019, 42(6): 562-565.
10.	Das De S, Sebastin SJ. Soft tissue coverage of the digits and hand. Hand Clin, 2020, 36(1): 97-105.
11.	胡玉慶, 宋利華, 馬天驍, 等. 帶部分尺側腕屈肌腱的尺動脈腕上皮支皮瓣修復手部復合組織缺損. 中華手外科雜志, 2020, 36(5): 386-387.
12.	鐘少開, 李培, 凌利, 等. 橈動脈穿支皮瓣修復手部皮膚缺損的臨床應用. 中華手外科雜志, 2019, 35(6): 422-424.
13.	孫從府, 房巍, 王增濤, 等. 手及前臂巨大皮膚缺損兩種皮瓣修復的方法和討論. 中國矯形外科雜志, 2019, 27(10): 954-955.
14.	陳壘壘, 王詒焓, 郭松雪, 等. 腹部帶蒂超薄皮瓣一期分指修復多指復合組織缺損. 實用手外科雜志, 2022, 36(1): 77-79.
15.	Ono S, Sebastin SJ, Ohi H, et al. Microsurgical flaps in repair and reconstruction of the hand. Hand Clin, 2017, 33(3): 425-441.
16.	歐昌良, 周鑫, 陳孝均, 等. 游離足底內側動脈皮瓣修復手掌部軟組織缺損. 中華顯微外科雜志, 2021, 44(3): 310-312.
17.	Wang Y, Wu T, Lu S, et al. Medial plantar venous flap: Classic donor site modification for hand defects. Ann Plast Surg, 2018, 81(4): 444-448.
18.	Wang L, Liu H, Ma T, et al. Reconstruction of soft tissue defects in the hand with a free anterolateral thigh deep fascia flap. Orthop Surg, 2021, 13(3): 758-767.
19.	鄭大偉, 朱輝, 陳步國, 等. 健康成人四肢兩點分辨覺的測定. 中華醫學雜志, 2018, 98(39): 3212-3214.

1. 路來金, 姜永沖, 張巨, 等. 手背逆行島狀皮瓣的臨床應用. 中華外科雜志, 1991, 29(10): 593-595.
2. Balan JR, Mathew S, Kumar P, et al. The reverse dorsal metacarpal artery flap in finger reconstruction: A reliable choice. Indian J Plast Surg, 2018, 51(1): 54-59.
3. Bordianu A, Leoveanu FI. Hand soft tissue reconstruction with dorsal metacarpal artery perforator (Quaba) flap. J Med Life, 2021, 14(5): 731-736.
4. 王培吉, 趙家舉, 張勇. 掌背動脈穿支蒂逆行筋膜皮瓣與蒂部微型瓣的設計與應用. 中華手外科雜志, 2013, 29(4): 212-214.
5. 王揚劍, 陳林海, 鄭雪紅, 等. 掌背動脈背側皮支皮瓣修復手指中末節軟組織缺損. 中華顯微外科雜志, 2018, 41(3): 213-215.
6. Chung KC, Pillsbury MS, Walters MR, et al. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg (Am), 1998, 23(4): 575-587.
7. Zhao F. Flap repair technique for soft tissue defects of the hand. Ann Plast Surg, 2021, 86(3S Suppl 2): S319-S321.
8. Seo BF, Kwon BY, Han HH. Sensate hypothenar perforator free flap for resurfacing large volar surface defect of the digit. Microsurgery, 2018, 38(4): 419-422.
9. 于春波, 劉鵬, 梁亞闖, 等. 第2掌背動脈-指背動脈蒂雙葉微皮瓣的應用解剖. 中華顯微外科雜志, 2019, 42(6): 562-565.
10. Das De S, Sebastin SJ. Soft tissue coverage of the digits and hand. Hand Clin, 2020, 36(1): 97-105.
11. 胡玉慶, 宋利華, 馬天驍, 等. 帶部分尺側腕屈肌腱的尺動脈腕上皮支皮瓣修復手部復合組織缺損. 中華手外科雜志, 2020, 36(5): 386-387.
12. 鐘少開, 李培, 凌利, 等. 橈動脈穿支皮瓣修復手部皮膚缺損的臨床應用. 中華手外科雜志, 2019, 35(6): 422-424.
13. 孫從府, 房巍, 王增濤, 等. 手及前臂巨大皮膚缺損兩種皮瓣修復的方法和討論. 中國矯形外科雜志, 2019, 27(10): 954-955.
14. 陳壘壘, 王詒焓, 郭松雪, 等. 腹部帶蒂超薄皮瓣一期分指修復多指復合組織缺損. 實用手外科雜志, 2022, 36(1): 77-79.
15. Ono S, Sebastin SJ, Ohi H, et al. Microsurgical flaps in repair and reconstruction of the hand. Hand Clin, 2017, 33(3): 425-441.
16. 歐昌良, 周鑫, 陳孝均, 等. 游離足底內側動脈皮瓣修復手掌部軟組織缺損. 中華顯微外科雜志, 2021, 44(3): 310-312.
17. Wang Y, Wu T, Lu S, et al. Medial plantar venous flap: Classic donor site modification for hand defects. Ann Plast Surg, 2018, 81(4): 444-448.
18. Wang L, Liu H, Ma T, et al. Reconstruction of soft tissue defects in the hand with a free anterolateral thigh deep fascia flap. Orthop Surg, 2021, 13(3): 758-767.
19. 鄭大偉, 朱輝, 陳步國, 等. 健康成人四肢兩點分辨覺的測定. 中華醫學雜志, 2018, 98(39): 3212-3214.

Chinese Journal of Reparative and Reconstructive Surgery

Repairing large skin defect of hand with modified dorsal metacarpal artery reverse island flap

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