First Dorsal Metacarpal Artery Flap
This chapter details essential steps of a first dorsal metacarpal artery flap procedure. The dorsal flap is harvested with the first dorsal metacarpal artery providing blood supply; the pedicle is mobilized and inset into the defect site. A full-thickness
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Nicholas Galardi and Zubin J. Panthaki
Indications
Essential Steps
1. Used as sensory flap for coverage of skin defects over the palmar surface of the thumb. 2. Reconstruction of dorsal thumb defects. 3. Reconstruction of the 1st web space (i.e., Contracture).
Preoperative Markings
Possible Complications 1 . Flap vascular compromise. 2. Index finger donor site morbidity such as stiffness, cold intolerance, unfavorable scarring, or neuroma.
1. The normal course of the first dorsal meta carpal artery is marked out along the dorsal aspect of hand along the first intermetacarpal space such that the skin of the MP joint is preserved; a lazy “S” incision is then drawn on the dorsum of the second metacarpal. 2. The flap is then drawn at the dorsum of the index finger over the proximal phalanx according to the size of the defect to cover; the width of the flap should not extend beyond the radial and ulnar mid-axial lines.
Intraoperative Details
N. Galardi, M.D. (*) Division of Plastic Surgery, Department of Surgery, University of Miami/Jackson Hospital, Miami, FL, USA e-mail: [email protected] Zubin J. Panthaki, M.D. Plastic, Aesthetic, and Reconstructive Surgery, Miller School of Medicine, University of Miami, Clinical research building. 4th floor, 1120 NW 14th Street, Miami, FL 33136, USA e-mail: [email protected]
1. Patient is sedated and regional/peripheral nerve block is administered. 2. Patient is sterilely prepped and draped. 3. Tourniquet is applied to the involved upper arm, with pressure that allows for exsanguination and a bloodless operating field. 4. Irrigation and debridement of the wound is performed. 5. Incision along the predesignated markings is made.
© Springer International Publishing Switzerland 2017 T.A. Tran et al. (eds.), Operative Dictations in Plastic and Reconstructive Surgery, DOI 10.1007/978-3-319-40631-2_93
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N. Galardi and Z.J. Panthaki
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6. The flap is then harvested from distal to proximal and radially to ulnarly preserving the paratenon overlying the extensor apparatus including the first dorsal metacarpal artery and a branch of the sensory radial nerve. 7. The pedicle flap is carried out proximally until reaching the most proximal point which lies between the bases of the first and second metacarpals (this also signifies the pivot point of the flap). 8. Safe dissection is achieved by including the radial shaft periosteum of the second MC bone along with the fascia of the first dorsal interosseous muscle. 9. Once the pedicle is mobilized the tourniquet is deflated to assess vascular flow of the flap. 10. The flap is then inset into the defect with 4-0 nylon sutures. 11. A full-thickness or split-thickness skin graft is then obtained from the patient’s antecubital fossa or the groin and placed at the donor site; sutured with 4-0 chromic sutures. 12. The skin graft is covered with a tie-over bolster dressing, a non-adherent dressing is placed over the flap and the entire hand is covered with fluffed gauze dressing; a small window is made
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