Modified First Dorsal Metacarpal Artery Flap to Prevent Venosus Congestion: Retrospective Analysis of 37 Cases

INTRODUCTION: First dorsal metacarpal artery flap (FDMAF) is thin, pliable, sensate flap which is useful in the restoration of the contour and sensation of the thumb. Although FDMAF stands out with many positive aspects, venous congestion and related flap losses are frequently reported in the literature. In this study, we evaluated the clinical results of our modification, which prevents venous congestion and facilitates the inset of the flap to the defect area, with retrospective patient analyzes. We aimed to share surgical anatomy, surgical technique, tips and key points to get good results.
METHODS: Between May 2016 and December 2019, 37 patients (32 males, 5 females) with thumb defects were included in the study. All patients were evaluated for flap size, defect size, sensory return, two-point discrimination(2PD), operation time, metacarpophalangeal (MCP) and interphalangeal (IP) range of motion.
RESULTS: All 37 flaps survived complately. Venous congestion was not observed in the other flaps. Semmes-Weinstein sensory test score: 4,36 (range, 3,84-5,1) in the flap, 4,62 range, 3,9-4,92) in the donor site. Mean two-point discrimination (2PD): 8.8 mm (range, 7-22 mm) in the flap, 12 mm in the donor area (range 10-14 mm). MCP range of motion of the operated thumbs was 82o (range, 70o-86o) and IP range of motion was 84o (range, 15o-88o).
DISCUSSION AND CONCLUSION: Modified kite flap is technically simple, and the learning curve is fast, even it may be performed with local anesthesia. Also it is a useful, reliable and sensory option for the thumb reconstruction. Our clinical results are encouraging.