Retrospective study of reverse dorsal metacarpal flap and compound flap: a review of 122 cases.
OBJECTIVE
To evaluate the clinical application and discuss the operative indication of the reverse dorsal metacarpal flap and its compound flap on the skin defects of hand.


METHODS
From 1990 to 2003, we applied the reverse dorsal metacarpal flap and its compound flap to repair soft tissue defects of fingers in 122 cases, which included 90 cases of the reverse metacarpal flap and 32 cases of its compound flaps with tendon grafts, nerve grafts or bone grafts. Based on the follow-up observations, we analyzed the indications of the reverse metacarpal flap and its compound flaps, the postoperative contours, flap colors and textures in comparison to contralateral fingers retrospectively.


RESULTS
In the series of 122 cases, flaps survived and the donor site defects were closed directly. The follow-up period ranged from 1-12 years. The postoperative contours, colors and textures of the flaps and its compound flaps were similar to those of normal fingers, although linear scar remained. According to standards of sense recovery (British Medical Research Council, BMRC), the sense function of the flaps resumed S3 after operation for 1 year. In 10 cases with the tendon defects treated by the flap with tendon grafts, function of flexion-extension of fingers resumed 50%-75% in comparison to the contralateral fingers using the method of measurement of total active motion. In 7 cases with the phalangeal nonunion or bone defects treated by the flap with bone grafts, union occurred after operation for 3 months.


CONCLUSIONS
To soft tissue defects on fingers with bone or tendon exposure, the reverse metacarpal flap and its compound flap are a better choice for repairing. The range of repairing is up to the distal interphalangeal joint of fingers. The second dorsal metacarpal artery is more consistent and larger as the choice of vascular pedicle, in comparison with other dorsal metacarpal arteries. Postoperative flap color and texture are similar to normal fingers.
Lu
Lai-jin
LJ
Department of Hand Surgery, The First Clinical College Affiliated to Jilin University, Changchun 130021, China. gongxu1973@yahoo.com.cn
Gong
Xu
X
Liu
Zhi-gang
ZG
Zhang
Zhi-xin
ZX
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008663:Metacarpus / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply; D016896:Treatment Outcome