[Foucher's first dorsal metacarpal artery island flap].

OBJECTIVE

Coverage of soft-tissue defects of the thumb, which cannot be covered primarily or with a skin graft, by a neurovascular pedicled island flap from the dorsum of the index finger.

INDICATIONS

Combined skin and soft-tissue defects of the back of the hand, the thumb web space, and especially the thumb.

CONTRAINDICATIONS

Damages to the first dorsal metacarpal artery or the rete carpale dorsale. Previous injuries to the flap donor area. Local infection.

SURGICAL TECHNIQUE

Outlining of the skin flap design on the dorsum of the index finger. S-shaped skin incision at first web space radially. Identification of the first dorsal metacarpal artery and preparation of a fascioneurovascular pedicle for flap supply, with involvement of the fascia of the dorsal interosseous muscle in the flap pedicle. Intersection of the island flap from the index finger. Preparation and uplifting of the flap. Tunneling of the island flap under a skin bridge into the covering defect on the thumb. Fixation and suturing of the flap in the defect. Coverage of the flap defect on the dorsum of the index finger with a skin graft.

POSTOPERATIVE MANAGEMENT

Immobilization with a cast for 7 days, followed by finger mobilization and wound care.

RESULTS

During the years 2005 and 2006, 15 major soft-tissue defects of the thumb in eleven men and four women were reconstructed using a neurovascular island flap of the first dorsal metacarpal artery. The results were comparable to those previously reported in the literature. All flaps healed completely without any complications. The two-point discrimination measured an average of 8.8 mm.