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.	陳拓, 謝燕敏, 黃秀云. 改良示指背側島狀皮瓣一期修復拇指末節缺損的效果評估. 中外醫學研究, 2020, 18(27): 118-119.
2.	龍航, 徐佳麗, 王玉波, 等. 拇指橈側指掌側固有動脈穿支蒂第一掌骨橈背側動脈皮瓣修復拇指軟組織缺損. 中華手外科雜志, 2020, 36(5): 321-323.
3.	陳一, 王家輝, 江克羅. 靜脈動脈化皮瓣修復拇指軟組織缺損30例. 中華顯微外科雜志, 2021, 44(1): 89-91.
4.	宋家林, 黃騰立, 高濤, 等. 游離腓動脈穿支皮瓣在足踝部軟組織缺損中的臨床應用. 中國修復重建外科雜志, 2021, 35(6): 756-760.
5.	冉小葉, 劉元波, 楊若夢, 等. 穿支螺旋槳皮瓣連續轉移技術在下肢遠端軟組織缺損修復中的臨床應用. 中國修復重建外科雜志, 2022, 36(4): 451-455.
6.	孫碩寧, 劉壯, 宋基學. 食指背側島狀皮瓣修復拇指背側大面積缺損. 中國傷殘醫學, 2020, 28(4): 47.
7.	施凱兵, 周振宇, 劉璠, 等. 掌背動脈逆行島狀皮瓣修復手指掌側軟組織缺損的感覺功能隨訪研究. 中華骨與關節外科雜志, 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.	榮向科, 石定, 劉剛義, 等. 兩種逆行拇指背側皮瓣修復拇指末節軟組織缺損的對比研究. 中國骨與關節雜志, 2021, 10(12): 956-960.
10.	Karakol P, Sezgi? 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.	王輝, 楊曉溪, 劉冰冰, 等. 手部三種近位帶蒂皮瓣接力修復手指指端脫套傷及供區軟組織缺損的效果. 中華燒傷雜志, 2021, 37(1): 64-69.

1. 陳拓, 謝燕敏, 黃秀云. 改良示指背側島狀皮瓣一期修復拇指末節缺損的效果評估. 中外醫學研究, 2020, 18(27): 118-119.
2. 龍航, 徐佳麗, 王玉波, 等. 拇指橈側指掌側固有動脈穿支蒂第一掌骨橈背側動脈皮瓣修復拇指軟組織缺損. 中華手外科雜志, 2020, 36(5): 321-323.
3. 陳一, 王家輝, 江克羅. 靜脈動脈化皮瓣修復拇指軟組織缺損30例. 中華顯微外科雜志, 2021, 44(1): 89-91.
4. 宋家林, 黃騰立, 高濤, 等. 游離腓動脈穿支皮瓣在足踝部軟組織缺損中的臨床應用. 中國修復重建外科雜志, 2021, 35(6): 756-760.
5. 冉小葉, 劉元波, 楊若夢, 等. 穿支螺旋槳皮瓣連續轉移技術在下肢遠端軟組織缺損修復中的臨床應用. 中國修復重建外科雜志, 2022, 36(4): 451-455.
6. 孫碩寧, 劉壯, 宋基學. 食指背側島狀皮瓣修復拇指背側大面積缺損. 中國傷殘醫學, 2020, 28(4): 47.
7. 施凱兵, 周振宇, 劉璠, 等. 掌背動脈逆行島狀皮瓣修復手指掌側軟組織缺損的感覺功能隨訪研究. 中華骨與關節外科雜志, 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. 榮向科, 石定, 劉剛義, 等. 兩種逆行拇指背側皮瓣修復拇指末節軟組織缺損的對比研究. 中國骨與關節雜志, 2021, 10(12): 956-960.
10. Karakol P, Sezgi? 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. 王輝, 楊曉溪, 劉冰冰, 等. 手部三種近位帶蒂皮瓣接力修復手指指端脫套傷及供區軟組織缺損的效果. 中華燒傷雜志, 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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