The Hip: Preservation, Replacement and Revision

Reverse Dorsal Metacarpal Flap



- Discussion:
    - dorsal metacarpal vessels contribute to the fascial plexus, which supplies the skin of the dorsum of the hand;
    - reverse dorsal metacarpal flap, based on the dorsal metacarpal arteries, can cover small soft-tissue defects in the hand;
    - axis of this flap parallels dorsal interosseous muscles;
    - subcutaneous fat, fascia, and dorsal metacarpal vessels are included in the flap and divided proximally;
    - proximal end of the flap is elevated and dissection of the flap and its pedicle is continued distally to the web space;
    - because fourth and fifth metacarpal arteries are absent in one third of cases, this flap might not be dependable on ulnar side.
    - second dorsal metacarpal artery neurovascular island flap:
         - used after release of first web contractures & to resurface radiopalmar and thumb defects;
         - it is proximally based, and if it is extended beyond proximal interphalangeal joint, distal flapnecrosis and donor-site difficulties can 
                result;
         - point at which extensor tendon to the index and long fingers separates is pivot point for flap pedicle;
         - dorsal interosseous fascia must be included with the pedicle over full width of the muscle to safeguard artery;
         - flap is dissected from distal to proximal;
         - communication with the palmar metacarpal artery is identified and ligated when the second web is reached;
         - flap is passed through subQ tunnel and the donor site closed with split thickness or full thickness skin graft



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, September 8, 2011 4:08 pm