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A Reliable and Useful Flap for Repair Defects of the Hand Fingers: Reverse Flow Dorsal Metakarpal Artery Pediculled Flaps

Year 2011, Year: 2011 Volume: 36 Number: 1, 1 - 7, 01.03.2011

Abstract

Reverse flow dorsal metacarpal artery pediculled flap is one of the easily apllicable and useful flap alternatives which are used for closing the defects of the hand fingers. The aim of this study is evaluate complications and outcomes of finger defects repairing with reverse flow dorsal metacarpal artery pediculled flap. From 1999 till 2009 we applied this technique for repairing fingers’ defects in totally of 15 patients. 5 of them represent after electric burn injury, 4 after endustrial trauma, 4 after excision of squamous cell carsinoma ( SCC ) and 2 after contracture opening procedure. Nine of them were male and 6 female with mean age of 39. Most of used arteries were 2nd or 3rd dorsal metacarpal. Follow ups for these patients lasted around 30 month (11 - 45 month). İn 2 patients flaps were lost due to inappropriate pedicle rotation and after the debridement of the flaps, the defects were repaired with “cross-finger” flaps. Reverse flow dorsal metacarpal flap which does not damage the major arterial system of the hand and is easily applicable and useful technique, has good skin color and tissue compatibility, and can be used for fingers’ defects repairing.

References

  • Al-Qattan MM. The adipofascial turnover flap for coverage of the ekspoze distal interphalangeal joint of the fingers and interphalangeal joint of the thumb. J Hand Surg [Am] 2001; 26: 1116-9.
  • Atasoy E. Reversed cross-finger subcutaneous flap. J Hand Surg [Am] 1982; 7: 481-3.
  • Benito JR, Ferreres A, Rodriguez-Baeza A, et al. Is the reversed fourth dorsal metacarpal flap reliable? J Hand Surg [Br] 2000; 25:135-139.
  • Chen SL, Chou TD, Chen SG, et al. The boomerang flap in managing injuries of the dorsum of the distal phalanx. Plas Reconstr Surg 2000; 106:834-839.
  • Dautel G, Merle M. Dorsal metacarpal reverse flaps. Anatomical basis and clinical application. J Hand Surg [Br] 1991; 16:400-405.
  • Dautel G, Merle M. Direct and reverse dorsal metacarpal flaps. Br.J Plast Surg 1992; 45: 125-130.
  • Early MJ, Milner RH. Dorsal Metacarpal flaps. Br J Plas Surg 1987; 40: 333-341.
  • El-Khatib H. Adipofascial axial pattern cross-finger flap. Plast Reconstr Surg 1996; 97: 850-3.
  • Foucher G, Braun JB. A new island flaps transfer from the dorsum of the index to the thumb. Plas Reconstr Surg 1979; 63: 344-3499.
  • Jing H, Liu XY, Ge BF, et al. The second dorsal metacarpal flap with vascular pedicle composed of the second dorsal metacarpal artery and the dorsal carpal branch of radial artery. Plast Reconstr Surg 1993; 92: 501–6.
  • Karacalar A, Ozcan M. A new approach to the reverse dorsal metacarpal artery flap. J Hand Surg [Am] 1997; 22:307–10.
  • Lai CS, Lin SD, Yang CC, et al. The adipofascial turnover flap for complicated dorsal skin defects of the hand and the finger. Br J Plast Surg 1991; 44: 165-9.
  • Lu LJ, Wan SF. Anatomical study and clinical appliance of the reverse dorsal metacarpal flap. The Fourth Symposium of the Chinese Association of Hand Surgery, Wu Xi City, 1990; 43:17–23.
  • Maruyama Y. The reverse dorsal metacarpal flap. Br J Plas Surg 1990; 43: 24-27.
  • Masqulet AC, Gilbert A. Intermetacarpal and dorsocommisural flaps. In: Masqulet AC, Gilbert A. (Editors). Flaps in limb reconstruction. 1st ed. London, Martin Dunitz; 1995, p:93-94.
  • Mc Grouther DA. Dupuytren’s contracture. In: Green DP, Hotchkiss RN, Pederson WC, (Editors). Green’s operative hand surgery, Vol 1. 4th ed. New York, Churchill Livingstone Co.; 1999. p.563-591.
  • Nishikawa H., Smith P.J. The recovery of sesation and function after cross-finger flaps for fingertip injury. J. Hand Surg. 1992, 17B (1): 102-107.
  • Pelissier P, Casoli V, Bakhach J, et. al. Reverse dorsal digital and metacarpal flaps: A review of 27 cases. Plast Reconstr Surg 1999; 103:159-165.
  • Peterson P., Titley O.G., Nancarrow J.D. Donor finger morbidity in cross finger flaps. Injury 2000, 31(4): 215-218.
  • Quaba AA, Davison PM. The distally-based dorsal hand flap. Br J Plas Surg 1990; 43: 28-39.
  • Santa-Comba A, Amarante J, Silva A, et. al. Reverse dorsal metacarpal osteocutaneous flap. Br J Plast Surg 1997; 50:555-558.
  • Steenlage E, Blazar P, Wegner D, et. al. A simple technique for testing the viability of cross-finger pedicle flaps. J Hand Surg.2001, 26B (1): 76-77.
  • Taçkın Ö, Hüseyin SY, Cengizhan K, ve ark. Ters akımlı dorsal metakarpal flep klinik uygulamaları. Ege Tıp Dergisi 2007; 46 (1) : 17-20.
  • Vivian M, James M, Benjamin C. The modified V-Y dorsal metacarpal flap for repair of syndactyly without skin graft. Plast. Reconstr. Surg. 2010; 125(1): 225- 232.
  • Yang D, Morris SF. Reversed dorsal digital and metacarpal island flaps supplied by the dorsal cutaneous branches of the palmar digital artery. Ann Plast Surg 2001; 46:444-449.

El Parmak Defektlerinin Onarımında Güvenilir ve Kullanışlı Bir Flep: Ters Akımlı Dorsal Metakarpal Arter Pediküllü Flep

Year 2011, Year: 2011 Volume: 36 Number: 1, 1 - 7, 01.03.2011

Abstract

El parmak defektlerinin kapatılmasında kullanılan, kolay uygulanan ve kullanılışlı flep seçeneklerinden birisi de ters akımlı dorsal metakarpal arter pediküllü fleptir. Bu çalışmada amaç; el parmak defekt onarımında kullandığımız ters akımlı dorsal metakarpal arter pediküllü flep uyguladığımız hastalarımızda aldığımız sonuçları ve komplikasyonları değerlendirmektir. 1999-2009 yıllar arası toplam 15 hastaya, el parmak defekt onarımı için ters akımlı dorsal metakarpal arter pediküllü fleple onarım uyguladık. Hastaların 5’inde elektrik yanığı, 4’ünde iş kazası, 4’ünde skuamoz hücreli karsinom ( SHK ) eksizyonu ve 2’sinde de kontraktür açılması sonrası oluşan defektler bulunmaktaydı. Hastaların 9’u erkek, 6’sı ise kadın ve ortalama yaş 39 idi. Çoğunlukla 2. veya 3. dorsal metakarpal arterler flep için kullanıldı. Operasyon sonrası hastalar ortalama 30 ay ( 11-45 ay ) süresince takip edildi. İki hastada pedikül rotasyonunun uygun olmaması nedeniyle flep nekrozu gelişti ve flep debridmanı yapıldıktan sonra defekt “cross-finger” flebiyle onarıldı. El parmak defektleri onarımı için kullandığımız, ters akımlı dorsal metakarpal arter pediküllü flep, elin majör arteriyel sistemini bozmayan, uygulanması kolay, kullanışlı, uygun renk ve doku uyumu sağlayan iyi bir flep seçeneğidir.

References

  • Al-Qattan MM. The adipofascial turnover flap for coverage of the ekspoze distal interphalangeal joint of the fingers and interphalangeal joint of the thumb. J Hand Surg [Am] 2001; 26: 1116-9.
  • Atasoy E. Reversed cross-finger subcutaneous flap. J Hand Surg [Am] 1982; 7: 481-3.
  • Benito JR, Ferreres A, Rodriguez-Baeza A, et al. Is the reversed fourth dorsal metacarpal flap reliable? J Hand Surg [Br] 2000; 25:135-139.
  • Chen SL, Chou TD, Chen SG, et al. The boomerang flap in managing injuries of the dorsum of the distal phalanx. Plas Reconstr Surg 2000; 106:834-839.
  • Dautel G, Merle M. Dorsal metacarpal reverse flaps. Anatomical basis and clinical application. J Hand Surg [Br] 1991; 16:400-405.
  • Dautel G, Merle M. Direct and reverse dorsal metacarpal flaps. Br.J Plast Surg 1992; 45: 125-130.
  • Early MJ, Milner RH. Dorsal Metacarpal flaps. Br J Plas Surg 1987; 40: 333-341.
  • El-Khatib H. Adipofascial axial pattern cross-finger flap. Plast Reconstr Surg 1996; 97: 850-3.
  • Foucher G, Braun JB. A new island flaps transfer from the dorsum of the index to the thumb. Plas Reconstr Surg 1979; 63: 344-3499.
  • Jing H, Liu XY, Ge BF, et al. The second dorsal metacarpal flap with vascular pedicle composed of the second dorsal metacarpal artery and the dorsal carpal branch of radial artery. Plast Reconstr Surg 1993; 92: 501–6.
  • Karacalar A, Ozcan M. A new approach to the reverse dorsal metacarpal artery flap. J Hand Surg [Am] 1997; 22:307–10.
  • Lai CS, Lin SD, Yang CC, et al. The adipofascial turnover flap for complicated dorsal skin defects of the hand and the finger. Br J Plast Surg 1991; 44: 165-9.
  • Lu LJ, Wan SF. Anatomical study and clinical appliance of the reverse dorsal metacarpal flap. The Fourth Symposium of the Chinese Association of Hand Surgery, Wu Xi City, 1990; 43:17–23.
  • Maruyama Y. The reverse dorsal metacarpal flap. Br J Plas Surg 1990; 43: 24-27.
  • Masqulet AC, Gilbert A. Intermetacarpal and dorsocommisural flaps. In: Masqulet AC, Gilbert A. (Editors). Flaps in limb reconstruction. 1st ed. London, Martin Dunitz; 1995, p:93-94.
  • Mc Grouther DA. Dupuytren’s contracture. In: Green DP, Hotchkiss RN, Pederson WC, (Editors). Green’s operative hand surgery, Vol 1. 4th ed. New York, Churchill Livingstone Co.; 1999. p.563-591.
  • Nishikawa H., Smith P.J. The recovery of sesation and function after cross-finger flaps for fingertip injury. J. Hand Surg. 1992, 17B (1): 102-107.
  • Pelissier P, Casoli V, Bakhach J, et. al. Reverse dorsal digital and metacarpal flaps: A review of 27 cases. Plast Reconstr Surg 1999; 103:159-165.
  • Peterson P., Titley O.G., Nancarrow J.D. Donor finger morbidity in cross finger flaps. Injury 2000, 31(4): 215-218.
  • Quaba AA, Davison PM. The distally-based dorsal hand flap. Br J Plas Surg 1990; 43: 28-39.
  • Santa-Comba A, Amarante J, Silva A, et. al. Reverse dorsal metacarpal osteocutaneous flap. Br J Plast Surg 1997; 50:555-558.
  • Steenlage E, Blazar P, Wegner D, et. al. A simple technique for testing the viability of cross-finger pedicle flaps. J Hand Surg.2001, 26B (1): 76-77.
  • Taçkın Ö, Hüseyin SY, Cengizhan K, ve ark. Ters akımlı dorsal metakarpal flep klinik uygulamaları. Ege Tıp Dergisi 2007; 46 (1) : 17-20.
  • Vivian M, James M, Benjamin C. The modified V-Y dorsal metacarpal flap for repair of syndactyly without skin graft. Plast. Reconstr. Surg. 2010; 125(1): 225- 232.
  • Yang D, Morris SF. Reversed dorsal digital and metacarpal island flaps supplied by the dorsal cutaneous branches of the palmar digital artery. Ann Plast Surg 2001; 46:444-449.
There are 25 citations in total.

Details

Primary Language Turkish
Journal Section Research
Authors

Erol Kesiktaş This is me

Rauf Kerimov This is me

Süphan Tunç This is me

Eyüphan Gencel This is me

Ömer Kokaçya

Publication Date March 1, 2011
Published in Issue Year 2011 Year: 2011 Volume: 36 Number: 1

Cite

MLA Kesiktaş, Erol et al. “El Parmak Defektlerinin Onarımında Güvenilir Ve Kullanışlı Bir Flep: Ters Akımlı Dorsal Metakarpal Arter Pediküllü Flep”. Cukurova Medical Journal, vol. 36, no. 1, 2011, pp. 1-7.