[Anatomy study and clinical application of island flap based on second dorsal metacarpal artery ].

Abstract

Objective: Through the anatomy study of the second dorsal metacarpal arteries (SDMA) and its cutaneous branches in fresh hand specimens, we explore the therapeutic effect of the island flap for the defect resulted from degloved avulsion injury of the fingers.

Methods: From January 2009 to September 2014,the cutaneous branches of second dorsal metacarpal arteries from 12 fresh hand specimens perfused by red latex were explored.21 fingers in 21 cases were treated with island flap based on SDMA and its cutaneous branches for skin defects at 11 index fingers,7 middle fingers or 3 thumbs.4 cases had combined fracture,5 cases had combined tendon injury.3 cases had combined neurovascular injury. The flaps size ranged from 5.0 cm × 6.5 cm to 2.5 cm × 5.0 cm.

Results: SDMA was originated from dorsal perforating branch of deep palmar arch. There were 4-6 cutaneous branches from SDMA distal intertendinous junction. The branches divided superfical vascular web to supply the dorsal skin on the second and third metacarpal.21 flaps based on SDMA survived successfully. After 5-27 months' follow up period, all these flaps recovered with satisfactory texture, grade S3 + sensation, and 7-11 mm two point discrimination. There were no obvious comphcations at the donor sites.

Conclusions: The cutaneous branches of distal SDMA is stable. The branches are composed of superfical vascular web above the second and third metacarpal. The flap based on SDMA is not necessary to sacrifice a major artery and can achieve good flap contour. The technique is recommendable. It can be easily and conveniently performed.