First dorsal metacarpal artery perforator-based propeller flap: functional anatomy and clinical application in soft-tissue defects of the dorsal hand and digits

Background Many approaches have been reported to repair soft-tissue defects of the hand using dorsal metacarpal artery flaps. Use of a perforator-based propeller flap from the first intermetacarpal space to the dorsum of the hand has been described. The aim of this study was to confirm the functiona...

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Bibliographic Details
Published in:Surgical and radiologic anatomy (English ed.) 2022-02, Vol.44 (2), p.215-221
Main Authors: Aizawa, Tetsushi, Hirayama, Takahiro, Kiyosawa, Tomoharu, Kobayashi, Yasushi
Format: Article
Language:English
Subjects:
Anatomic Bases of Medical
Anatomy
Aplasia
Cadavers
Functional anatomy
Hand - surgery
Hands
Humans
Imaging
Medicine
Medicine & Public Health
Metacarpal
Metacarpal Bones - surgery
Orthopedics
Perforator Flap
Radiological and Surgical Techniques
Radiology
Reconstructive surgery
Reconstructive Surgical Procedures
Surgery
Ulnar Artery
Veins & arteries
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Summary:Background Many approaches have been reported to repair soft-tissue defects of the hand using dorsal metacarpal artery flaps. Use of a perforator-based propeller flap from the first intermetacarpal space to the dorsum of the hand has been described. The aim of this study was to confirm the functional anatomy of a first dorsal metacarpal artery (FDMA) perforator flap. Methods Twenty-nine fixed cadaveric hands were dissected to determine the origin, course, and branches of the FDMA. Clinically, five cases of soft tissue defects of the hand underwent reconstructive surgery using an FDMA perforator-based propeller flap. Results The FDMA was found in 27 specimens (93%). The ulnar branch of the FDMA always supplied the cutaneous perforator (mean ± SD, 4.3 ± 1.6), and the most distal cutaneous perforating branch was found along the metacarpal long axis within 25 mm of the tip of the metacarpal head with high frequency (28/29, 97%). In the two hands that had aplasia of the FDMA, well-developed perforators arose directly from the radial artery and advanced to the metacarpal head. Seven hands (24%) had perforators arising from the palmar arterial system, penetrating through or passing close by the second metacarpal bone. In clinical application, all the flaps survived completely without major complications. Conclusions The FDMA perforator-based propeller flap is minimally invasive and technically simple. It is expected to be a new option for hand reconstruction.
ISSN:0930-1038
1279-8517
DOI:10.1007/s00276-021-02845-z