- 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 flap
necrosis 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;
