The second dorsal metacarpal artery flap with double pivot points.

A flap with double pivot points based on the second dorsal metacarpal artery was used in 13 cases with no complete failures. In 2 cases, the branches of the radial nerve were included in the flap. In 1 case, the flap was used as a tenocutaneous flap with a segment of the extensor indicis proprius tendon. To obtain a flap with double pivot points, the dissection of the vascular pedicle of a distally based second dorsal metacarpal flap is continued proximally under the second dorsal metacarpal artery up to its origin. In this flap the main pivot point coincides with the origin of the SDMA and the second pivot point with the entry point of the recurrent cutaneous branch into the flap. We found this flap to be very versatile, reliable, and quite easy and quick to raise. We report our experience with this flap as a very useful addition to reconstructive procedures, especially for thumb defects.