The evolution and refinements of the distally based dorsal metacarpal artery (DMCA) flaps

Summary Distally based DMCA flaps are well established in reconstructive hand surgery. They comprise the dorsal flap described by Quaba and the DMCA flaps described by Earley, Milner and others. The most frequent indications for these flaps are soft tissue defects of the dorsum of the proximal phala...

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Bibliographic Details
Published in:Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2007-01, Vol.60 (7), p.731-739
Main Authors: Gregory, H, Heitmann, C, Germann, G
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Arteries - anatomy & histology
Burned hands
Burns - surgery
Child, Preschool
DMCA flap
Dorsal metacarpal arteries
Fascial flap
Female
Finger Injuries - pathology
Finger Injuries - surgery
Finger Phalanges - surgery
Hand - microbiology
Humans
Infection - surgery
Male
Metacarpus - blood supply
Metacarpus - pathology
Middle Aged
Necrosis
Plastic Surgery
Postoperative Complications
Reconstructive Surgical Procedures - methods
Soft Tissue Injuries - pathology
Soft Tissue Injuries - surgery
Surgical Flaps - blood supply
Surgical Flaps - pathology
Treatment Outcome
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Summary:Summary Distally based DMCA flaps are well established in reconstructive hand surgery. They comprise the dorsal flap described by Quaba and the DMCA flaps described by Earley, Milner and others. The most frequent indications for these flaps are soft tissue defects of the dorsum of the proximal phalanx and the total length of the finger. Since its introduction several modifications have been developed to match specific defect requirements; these include: the development of pure fascial DMCA flaps, the use of DMCA flaps in dorsally grafted burned hands and modifications in design to avoid ‘tunnelling’ and to permit skin-skin defect closure. The purpose of this article is to provide an overview of the evolution and refinements of the DMCA flaps based on the experience of a single centre. The DMCA flaps provide one stage coverage of excellent quality with independent vascularisation and permit primary closure of the recipient site without sacrificing relevant arteries (e.g. proper digital artery). However, the DMCA flaps also possess drawbacks, for example, apart from the fact that this technique is quite demanding, possible hair growth and a visible scar on the exposed dorsal part of the hand present aesthetic problems for some patients. Despite these limitations, DMCA flaps are considered to be extremely useful.
ISSN:1748-6815
1878-0539
DOI:10.1016/j.bjps.2007.03.011