PURPOSE: The second
dorsal metacarpal artery flap from the
middle finger is a
reconstructive technique that can be used to repair extensive volar defects in a normal-length
thumb. However, few reports advocate using it for coverage of volar
thumb defects. In this article, an
anatomic study of 9 flaps used for resurfacing
thumb defects is presented along with the clinical experience of the authors. METHODS: From 2004 to 2006, 9 patients (6 men and 3 women;
mean age, 33 years; range, 18-51 years) with extensive volar defects of their normal-length
thumbs had reconstruction using the described technique. In all cases, the first
dorsal metacarpal artery flap technique was unable to be used because of
injury. Donor sites were covered using full-thickness
skin grafts. After
surgery, the
thumb was immobilized with a splint, followed by rehabilitation. During the follow-up period, which lasted 24 to 30 months, flap-site
skin quality,
scar contractures, and
finger mobility were assessed. The
range of motion of the
hand was measured by a
goniometer. Sensibility was evaluated by the 2-point discrimination test and the Semmes-Weinstein monofilament test.
Cold intolerance was also assessed. RESULTS: Patient postoperative courses were uneventful, and all flaps survived completely without complication. Good coverage was obtained in all cases. Full active
range of motion was observed in all patients in both the donor
finger and the
thumb. The
mean Semmes-Weinstein sensitivity and 2-point discrimination scores of the flap were 4.02 g and 8.4 mm, respectively. Mild
cold intolerance was observed in all of the
thumbs. CONCLUSIONS: The second
dorsal metacarpal artery flap from the
middle finger is a single-stage flap that produces good results. Although its pedicle length is limited, it is reliable and can be used as an alternative for reconstruction of extensive thumb-pulp defects, especially when the first
dorsal metacarpal artery flap cannot be used. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
