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Defining the anatomic boundaries of the dorsal metacarpal artery flap: An indocyanine-green study
Justin Davis, MD
1; Justin D Sawyer, MD
2; Timothy H Daugherty, MD
31Southern Illinois University, Springfield, IL; 2Institute For Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL, Springfield, IL; 3Southern Illinois University School of Medicine, Springfield, IL
Introduction: The Dorsal metacarpal artery perforator flap (DMAP, Quaba flap) is a versatile option for reconstruction of the hand and digits that prevents the need for larger, more distant, axial flaps. Previous reports describe flap dimensions as up to 9 cm in length, 3.5 cm in width, and 27 cm
2 in size, however, actual flap size limitations have not been tested. In this study, we investigated the perfusion area of the second dorsal metacarpal artery perforator using the Quantitative Perfusion mode from SPY Elite.
Materials and Methods: 7 fresh cadavers were used for the study. The entirety of the dorsal hand skin was widely elevated across the 2
nd-5
th metacarpal heads from the webspace to 10 cm proximal to listers tubercle on the 2
nd DMAP. Communicating branches and veins were clipped and Indocyanine Green (ICG) dye was injected directly into the 2
nd DMA. SPY Elite (Stryker labs) was used to identify the limits of the perforasome by measuring ICG perfusion. The perfusion was measured using quantitative processing to demonstrate areas of high and low perfusion. The dimensions of the flap were measured with imaging software and descriptive statistics were used to compare values.
Results: The Quantitative perfusion technique properly demonstrated areas of flap perfusion. The average 2
nd DMAP flap perfusion area was 71.23 cm
2. The average length of the flap was 11 cm from the perforator in the webspace. The width of the flap was across the entire transverse elevated portion consistently. The flap extended about 2.7 cm past the extensor retinaculum on average. The single perforator was able to provide perfusion for the entire dorsum of the hand in all specimens (7/7).
Conclusion: Quantitative perfusion was an adequate way to assess perfusion area of the 2
nd DMAP flap in cadavers. The area of the 2
nd DMAP flap that can be harvested is 2.6 times what is previously described. Knowledge of this can allow for the flaps potential use for larger local reconstruction. We demonstrate that almost the entire dorsal hand skin can be elevated on a single 2
nd DMA.
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