American Association for Hand Surgery

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Reconstruction of Defects on the Dorsum of the Hands with Dorsal Metacarpal Artery-based Fascial Flaps Harvested through the Borders of the Defects to Avoid Scars at the Recipient Sites in 28 Cases
Xuchao Luo, MD, Southwestern Medical University, Luzhou, China

Introduction: To describe reconstruction of defects on the dorsum of the hands using the fascial flaps based on one of the dorsal metacarpal arteries (DMAs), which were harvested through the borders of the defects under loupes and headlight to avoid scars at the recipient sites.

Materials & Methods:From January 2014 to March 2017, 28 patients (28 hands) with soft tissue defects on the dorsum of the hands were treated using the fascial flaps based on one or more of the DMAs. All flaps were antegrade pedicled flap. At the final follow up, range of motion of the metacarpophalangeal joints were assessed.

Results:In this series, we used the first DMA in 12 cases, the second DMA in 6 cases, the third DMA in 2 cases, the fourth DMA in 5 cases, and a combination of two DMAs in 3 cases. The average size of the defects was 3.2 cm × 3.8 cm. The average size of the flaps was 3.6 cm × 4.2 cm. The average length of the pedicle was 3.1 cm. All flaps survived. Range of motion of the second to fifth metacarpophalangeal joints reached 91% to 97% of the opposite hand. The span of the first web reached 96% of the opposite hand.

Conclusions:The DMA-based fascial flaps can be an option for reconstruction of the defects on the dorsum of the hands. Because the flaps were harvested through the border of the defect, additional scars at the donor sites can be avoided, resulting in a good appearance.

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