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Using Dorsal Metacarpal Artery Perforator Flap in the Soft Tissue Reconstruction of Finger Necrotizing Infection: A Case Series
Dun-Hao Chang, MD1; Ke-Chung Chang, M.D.2
1Taipei Veterans General Hospital, Taipei, Taiwan; 2Far Eastern Memorial Hospital, New Taipei City, Taiwan

Introduction

Necrotizing soft tissue infection (NSTI) in upper limb is uncommon and it is even rarer in the finger. After surgical debridement, skin and soft tissue defect would be sometimes encountered. The soft tissue reconstruction of finger is a challenge due to the limitations of local tissue availability. The dorsal metacarpal artery perforator (DMAP) flap is a vascular island flap raised on the dorsum of the hand, and it is a good option for finger reconstruction by replacing similar-for-similar in a single operation. In this study, we would like to share our experience of using DMAP flap in cases of finger defects resulted from NSTI.

Materials and Methods

From October 2020 to July 2024, patients who had suffered from finger NSTI had undergone DMAP flap for soft tissue reconstruction were examined. The patients' demographic data, injury and flap characteristics, wound healing status and complications were collected and studied.

Results

There was a total of four patients included in this study. Case 1 was a 73-year-old man with dorsal middle finger NSTI. Case 2 was a 68-year-old woman with middle finger pyogenic tenosysnovitis. Case 3 was a 28-year-old man with 3rd web space collar button abscess. Case 4 was a 71-year-old woman with distal interphalangeal joint septic arthritis and subsequent necrotizing tenosynovitis. These patients all had successful DMAP flap reconstruction except one patient had a partial flap necrosis, which required additional debridement and skin graft. The wounds healed well at the last follow-up.

Conclusions

The DMAP flap offers a thin and pliable skin to reconstruct finger defects within one-stage surgery. It's easy to harvest with reliable and constant circulation. With adequate design, the DMAP flap can be used to resurface both volar and dorsal finger defects. The DMAP flap is the ideal flap for reconstruction of NSTI related finger defects.

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