Utilization of first and second dorsal metacarpal artery flaps for reconstruction of soft tissue defects of thumb and first webspace: Reproducible and safe options for reconstruction.

Background: Soft tissue reconstruction of thumb and first web-space requires robust and sensate flaps. First and second dorsal metacarpal artery flaps are excellent options for such cases. Variable survival and sensory restoration is reported due to different surgical techniques. We present our technique and outcome to help a novice surgeon safely and confidently utilize these flaps.
Methodology: This prospective case series was conducted from July 2017 to December 2019. Patients requiring thumb and first web space soft tissue reconstruction were included. Flap necrosis, hypertrophic scarring, two point discrimination and active range of motion were noted to assess outcome.
Results: A total of 17 patients were included, 11 (64.7%) underwent reconstruction with first dorsal metacarpal artery (FDMA) flap and 6 (35.3%) with second dorsal metacarpal artery (SDMA) flap. 7.7 ± 0.75 mm was the average two-point discrimination with FDMA flap and 8.0 ± 0.63mm with SDMA flap. 7 out of 11 (63.6%) developed sensory reorientation with FDMA flap and 2 (33.3%) out 6 with SDMA flap. Mean angle of donor index finger metacarpophalangeal joint (MCPJ) was 79.4° and 91.9° of proximal interphalangeal joint (PIPJ) when FDMA was utilized. Mean angle of index finger MCPJ was 80.2° and PIPJ 90.2,middle finger MCPJ was 81.7 and 98.5 at PIPJ when SDMA was utilized. Flap necrosis was not observed in any case.
Conclusion: First and second dorsal metacarpal artery flaps are sensate and robust options to reconstruct thumb and first web-space defects.

Key Words: First dorsal metacarpal artery flap, Second dorsal metacarpal artery flap, Thumb reconstruction, first web space reconstruction.

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