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A Bilobed Second Dorsal Metacarpal Artery-Based Island Flap for Thumb Replantation
Ren Chunzhen, MD1; Shao Xinzhong, MD2; Xu Zhang, MD1; Xu Mi, MD1; Hongwei Zhu, MD1; Qiurong Zhang, MD1
1The Second Hospital of Qinhuangdao, China; 2Third Hospital of Hebei Medical University, China

Introduction: To introduce the use of a bilobed second dorsal metacarpal artery-based island flap taken from both the index and long fingers for reconstruction of the defect of the proximal phalanx of the thumb and preservation of the normal thumb length.
Materials & Methods: From March 2004 to March 2011, 24 patients with completely amputated thumbs associated with extensive defect of the proximal phalanx were replanted and reconstructed. The patients are 20 men and 4 women, with an average age of 34 years. In all cases, the proximal phalanx was reconstructed with a bone graft harvested from the iliac crest, which was covered with a bilobed second dorsal metacarpal artery-based island flap. After flap transfer, anastomoses between the veins of the distal part of the thumb and the flap were performed. At the final follow-up, we assessed the mean active range of motion of the metacarpophalangeal and interphalangeal joints of the thumb and the span of the first web in the thumbs that survived. Active motion of the donor fingers was also assessed.
Results: In this group, 20 thumbs survived and 4 failed. All flaps survived completely. At the mean follow-up of 25 months, the mean active motion arc of metacarpophalangeal and interphalangeal joints were 36° and 34°, respectively. Full range of motion was attained in all patients in both the metacarpophalangeal and the proximal interphalangeal joints of the donor index and long fingers.
Conclusions: Bilobed second dorsal metacarpal artery-based island flap transfer is a useful and reliable technique for thumb replantation when there is an extensive defect of the proximal phalanx and when a single-digit dorsal metacarpal artery island flap is too small.


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