Direct and reverse dorsal metacarpal flaps.

We reviewed the anatomy of vascular systems used for both direct and reverse dorsal metacarpal flaps. The three-dimensional arrangement of the dorsal arterial network of the hand was examined. The collateral and terminal branches of this dorsal arterial network are described as a potential source of blood supply for composite flaps. Three types of dorsal-palmar anastomotic network were identified at the first and second metacarpal spaces, in the web space area. They could provide blood supply to reverse metacarpal flaps. Results of a series of 12 cases of reverse metacarpal flaps are given.