Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University, Ankara, Turkey.
Department of Plastic, Reconstructive and Aesthetic Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
Microsurgery. 2024 Jan;44(1):e31057. doi: 10.1002/micr.31057. Epub 2023 May 18.
Volar finger contractures can be challenging for plastic surgeons. The dorsal metacarpal artery perforator (DMCAP) flap is frequently used to cover bones, tendons, and neurovascular structures in the dorsum of the hand after trauma and burns as an alternative to grafts and free flaps. We aimed to report volar finger defect reconstruction with expanded DMCAP flap. A 9-year-old male patient applied to our clinic with the complaint of inability to open the second finger of the left hand after an electrical burn that caused proximal and distal interphalangeal joints flexion contractures. Reconstruction was planned for the patient with a two-session expanded first DMCAP flap. A 16 mL 5 × 3 cm tissue expander was placed in the prepared area from the vertical incision in the first session. The tissue expander was inflated with 4 mL of isotonic solution. The DMCA area was enlarged 6 weeks later by giving 22 mL of isotonic solution. After the pedicle dissection, the 9 × 3 cm DMCAP flap was elevated by dissection over the paratenon. With 180° of rotation, the left-hand second finger was adapted to the 6 × 2 cm defect area on the volar face. The flap donor site was closed primarily. The operation was terminated by placing the hand on a protective splint. There were no complications in the flap in the postoperative 6 months. The patient was referred to the physical therapy and rehabilitation department. As a result, an expanded DMCAP flap may cover volar tissue defects up to the distal phalanx. This report may present the first case in which volar finger contracture reconstruction was performed with an expanded first DMCAP flap after an electrical burn in a pediatric patient.
掌侧手指挛缩对整形外科医生来说是一个挑战。背侧指总动脉穿支（DMCAP）皮瓣常用于创伤和烧伤后手背部的骨骼、肌腱和神经血管结构的覆盖，可替代移植物和游离皮瓣。我们旨在报告采用扩张的 DMCAP 皮瓣进行掌侧手指缺损重建。一名 9 岁男性患者因电击伤就诊，左手第二指无法伸直，表现为近侧指间关节和远侧指间关节屈曲挛缩。计划为患者进行两期扩张的第一 DMCAP 皮瓣重建。在第一期手术中，从垂直切口在准备好的区域内放置一个 16mL 的 5×3cm 组织扩张器。用 4mL 等渗溶液给组织扩张器充气。6 周后，通过给 22mL 等渗溶液将 DMCA 区域扩大 6 周。在蒂部解剖后，通过在腱旁切开将 9×3cm 的 DMCAP 皮瓣提起。皮瓣以 180°旋转，左手第二指适应掌侧 6×2cm 的缺损区域。皮瓣供区直接缝合。将手放在保护性夹板上结束手术。术后 6 个月皮瓣无并发症。患者被转至物理治疗和康复科。因此，扩张的 DMCAP 皮瓣可覆盖远节指骨的掌侧组织缺损。本报告可能为首例在儿童患者电击伤后采用扩张的第一 DMCAP 皮瓣进行掌侧手指挛缩重建的病例。
