First and second dorsal metacarpal artery free flap in a degloving case
DOI:
https://doi.org/10.18203/2320-6012.ijrms20254389Keywords:
Kite flap, Microsurgery, Digital degloving, Free flap, Case reportAbstract
Digital degloving injuries are uncommon but represent a significant challenge in hand surgery due to the circumferential loss of coverage, bone exposure, and functional compromise. Although multiple reconstructive options have been described, none has become the gold standard, and in many cases the outcome ends in amputation. We report a 55-year-old male patient with a circumferential degloving injury of the left index finger, showing complete bone exposure of the middle and distal phalanges and partial exposure of the proximal phalanx. Surgical management consisted of debridement and resection of necrotic tissue, followed by reconstruction using two synchronous contralateral free Kite flaps to cover the dorsal and volar surfaces, in addition to a full-thickness skin graft to the residual radial wound. Postoperative evolution was satisfactory, with 90% graft integration and complete flap viability. At six months, the donor site exhibited full healing, preserved mobility, intact pinch function, and no residual pain. The synchronous use of double free Kite flaps constitutes an innovative, anatomically faithful, and low-morbidity alternative for managing circumferential digital injuries. This case expands the clinical spectrum of the kite flap and suggests new possibilities for application in complex microsurgical hand reconstruction.
Metrics
References
Singh AP, Dixit PK, Agrawal D, Deepti K, Shilpi K, Priyanka S, et al. Dorsal metacarpal artery perforator flaps for traumatic soft tissue defect of finger: a prospective anatomical and clinical study. Chin J Traumatol. 2020;23(5):292-7.
Abdel-Ghani A, Maher M. First dorsal metacarpal artery perforator flap for thumb and finger defects. J Hand Surg Eur Vol. 2020;45(4):395-401.
Bakhach J, Choughri H, Ghanem AM, Qassemyar Q. First dorsal metacarpal artery flap: A versatile solution for defects of the thumb and the hand. Arch Plast Surg. 2022;49(2):181-6.
Ozdemir R, Mavili E, Sevin K, Baran CN. First dorsal metacarpal artery island flap: Clinical experience with 24 cases. Plast Reconstr Surg. 2002;110(5):1091-7.
Shen XF, Mi JY, Xue MY, Gang Z, Li Q, Xiao Z, et al. Modified great toe wraparound flap with preservation of plantar triangular flap for reconstruction of degloving injuries of the thumb and fingers: Long-term follow-up. Plast Reconstr Surg. 2016;138(1):155-63. DOI: https://doi.org/10.1097/PRS.0000000000002301
Krishnamoorthy R, Karthikeyan G. Degloving injuries of the hand. Indian J Plast Surg. 2011;44(2):227-36. DOI: https://doi.org/10.4103/0970-0358.85344
Lin C, Chen S, Chen T, Niann-Tzyy D, Shun-Cheng C. Free fasciocutaneous flaps for reconstruction of complete circumferential degloving injury of digits. Microsurgery. 2013;33(3):191-7. DOI: https://doi.org/10.1002/micr.22064
Amjed H, Heffernan A, Mahajan AL. Dorsal metacarpal artery perforator flaps for resurfacing digital defects: a reliable, thin and sensate option. J Plast Reconstr Aesthet Surg. 2018;71(6):833-9.
Chi Z, Gao W, Yan H, Li Z, Chen X, Zhang F. Reconstruction of totally degloved fingers with a spiraled parallelogram medial arm free flap. J Hand Surg Am. 2012;37(5):1042-50. DOI: https://doi.org/10.1016/j.jhsa.2012.02.010
Couceiro J, de Prado M, Menéndez G, Manteiga Z. The first dorsal metacarpal artery flap family: a review. Surg J (N Y). 2018;4(4):e215-9. DOI: https://doi.org/10.1055/s-0038-1675369
Yazar S, Lin CH, Lin YT, Wei FC. Outcome comparison between free anterolateral thigh and radial forearm flap in reconstruction of large soft-tissue defects around the elbow. Plast Reconstr Surg. 2006;117(7):2468-75. DOI: https://doi.org/10.1097/01.prs.0000224304.56885.c2
Foucher G, Braun JB. A new island flap transfer from the dorsum of the index to the thumb. Plast Reconstr Surg. 1979;63(6):344-9. DOI: https://doi.org/10.1097/00006534-197903000-00008
Hongwei L, Yichen L, Jun Z. The use of dorsal metacarpal artery perforator flaps in the treatment of finger soft tissue defects. J Reconstr Microsurg. 2020;36(4):301-7.
Krishnan NM, Fischer LH, Friedrich JB. The first dorsal metacarpal artery perforator free flap for resurfacing complex hand and digit defects. J Reconstr Microsurg. 2014;30(6):403-10.
Stulpinas A, Venciūtė-Stankevičė R, Jakutis N. Surgical treatment of finger degloving injuries without usable skin: a case report and literature review. Lietuvos Chirurgija. 2022;21(3-4):229-37. DOI: https://doi.org/10.15388/LietChirur.2022.21.70
Dautel G, Merle M, Borrelly J, Michon J. Variations anatomiques du réseau vasculaire de la première commissure dorsale: Applications au lambeau cerf-volant. Ann Chir Main. 1989;8(1):53-9. DOI: https://doi.org/10.1016/S0753-9053(89)80045-6
Zyluk A, Flicinski F. Outcomes of coverage of soft tissue defects in the thumb with a “Kite flap”. Handchir Mikrochir Plast Chir. 2023;55(1):47-52. DOI: https://doi.org/10.1055/a-1862-8129
Tos P, Titolo P, Chirila NL. Free dorsal metacarpal artery perforator flap for complex defects of the fingers: anatomical basis and clinical experience. J Hand Surg Eur Vol. 2013;38(4):410-7.
Downloads
Published
How to Cite
Issue
Section
