[The distally based dorsal metacarpal artery flap (DMCA)].

OBJECTIVE

Regional flap for the reconstruction of combined skin and soft-tissue defects of the fingers or the distal parts of the palm.

INDICATIONS

Full-thickness soft-tissue defects of the fingers dorsally up to the distal interphalangeal joint, of the fingers palmarly up to the middle phalanx, or of the distal parts of the palm.

CONTRAINDICATIONS

Damage of the dorsal metacarpal artery or of the distal anastomosis by trauma or previous operation. Ongoing infections.

SURGICAL TECHNIQUE

Preoperative Doppler examination. Planning of a flap using the proximal or distal anastomosis of the metacarpal artery with the palmar system as its pivot point. Raising of an adipofascial flap including as many veins as possible. Alternatively, the metacarpal artery can be raised alone as a fascial flap. Tension-free insertion of the flap into the defect. To avoid venous congestion, we do not recommend subcutaneous tunneling of the flap. The skin bridge should be incised instead.

POSTOPERATIVE MANAGEMENT

Loose cotton dressing, periodic monitoring, bed rest for 5 days. After 3 days active and passive physiotherapy can start. Suture removal after 14 days.

RESULTS

Reliable and relatively secure flap with a flap loss rate up to 20% in literature. The donor site can be closed primarily up to a flap width of 2 cm. The fourth metacarpal artery is missing in up to 30% of the cases.