Multi-dorsal metacarpal artery perforator adipofascial turnover flap for index to little finger reconstruction: Anatomical study and clinical application

• Published in: Hand surgery and rehabilitation 2021-04, Vol.40 (2), p.177-182
• Main Authors: Facchin, F., Sonda, R., Faccio, D., Stecco, C., Angelini, A., Ruggieri, P., Bassetto, F., Tiengo, C.
• Format: Article
• Language: English
• Subjects: Anatomie; Anatomy; Artère métacarpienne dorsale; Chirurgie de la main; Dorsal metacarpal artery; Finger reconstruction; Hand surgery; Lambeaux métacarpiens dorsaux inversés; Reconstruction des doigts; Reverse dorsal metacarpal flaps
• ISSN: 2468-1229; 2468-1210
• DOI: 10.1016/j.hansur.2020.11.004

Reconstruction of the dorsum of the hand and fingers is one of the main challenges in hand surgery. Regional flaps from the forearm, free flaps, or pocket procedures are options when multiple digits are injured with tendon damage and bone exposure. These procedures can be technically demanding and are often plagued by a texture mismatch. We conducted an anatomical study of 20 fresh frozen hands. The second, third and fourth intermetacarpal spaces were analyzed with the aim of defining the vascular foundation of dorsal hand adipofascial-turnover flaps based on dorsal metacarpal artery (DMA) perforators, analyzing their potential for reconstruction procedures on the dorsum of the hand. In three cases, the 4th intermetacarpal space lacked the DMA. A mean of 3.5 arterial communications were found between the DMA and palmar arterial system. Each hand had 11 ± 2 dorsal skin perforators, which were equally distributed among different intermetacarpal spaces. At least one perforator was present in each one-third of the space. The most distal perforators were the largest in all spaces but missing in two hands. A clinical case of multiple index finger to little finger reconstruction with this new multi-dorsal metacarpal artery perforator (mDMAP) adipofascial turnover flap is presented. Our anatomical study confirmed previous descriptions of the anatomy of the dorsum of the hand. It supports the safety of the mDMAP adipofascial turnover flap based on all distal arterial perforator for the simultaneous reconstruction of index to little finger injuries. Similarly, adipofascial turnover flaps can be raised from more proximal perforators arising from DMAs if more than one intermetacarpal space is included. La reconstruction du dos de la main et des doigts représente l'un des principaux défis de la chirurgie de la main. Les lambeaux régionaux de l'avant-bras, les lambeaux libres ou les empochements sont envisagés en cas de blessures à plusieurs doigts avec lésion tendineuse et exposition osseuse. Ces techniques peuvent être techniquement exigeantes et sont souvent affectées par une inadéquation esthétique. Nous avons mené une étude anatomique sur 20 mains fraîches congelées. Les 2ème, 3ème et 4ème espaces intermétacarpiens ont été analysés dans le but de définir la base vasculaire de lambeaux de rotation adipofasciaux de la face dorsale de la main à partir de perforateurs des artères métacarpiennes dorsales (DMCA) analysant leur potentiel pour la reconstruction du dos de l