title: Dorsal metacarpal artery flaps with extensor indices tendons for reconstruction of digital defects.
abstract: BACKGROUND
  Distally based dorsal metacarpal artery (DMCA) flaps are an established technique for the reconstruction of extensive finger defects. In many cases, such defects also include an injury of the extension tendon over the proximal and distal finger joint, which can lead to a reduced range of motion or finger deformation such as boutonniére deformity. To prevent this, operative techniques are necessary that allow complete defect coverage while simultaneously stabilizing the extension apparatus.
  
  
  METHODS
  In two cases, DMCA flaps were combined with vascularized extensor indices tendons for the reconstruction of extensive dorsal finger skin and soft tissue defects, particularly when tendon and bone are exposed.
  
  
  RESULTS
  After three weeks of postoperative immobilization, physiotherapy could be intensified. In a six months' follow-up, the results obtained from the standpoint of both function and appearance were excellent, the flaps remained viable at all times and full-finger length and sensory function were maintained. Regarding operation time, pain and finger appearance, both patients stated satisfaction.
  
  
  CONCLUSIONS
  The vascularized tendon incorporated in DMCA flaps provides a sufficient method to restore a satisfactory finger function and prevent finger deformity, arthrodesis, or amputation, especially in cases with severe injuries of the extension apparatus.
authors.affiliation: Department of Plastic, Reconstructive, Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University, Tuebingen, Germany.
authors.forename: Jennifer Lynn
authors.initials: JL
authors.lastname: Schiefer
authors.forename: Hans-Eberhard
authors.initials: HE
authors.lastname: Schaller
authors.forename: Afshin
authors.initials: A
authors.lastname: Rahmanian-Schwarz
mesh_terms: D000368:Aged; D001158:Arteries / Q000601:surgery; D005383:Finger Injuries / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008663:Metacarpus / Q000098:blood supply / Q000601:surgery; D008875:Middle Aged; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply*; D013710:Tendons / Q000098:blood supply* / Q000601:surgery*