Comparison of first dorsal metacarpal artery flap done by consultants and residents and guidelines for improving outcome for beginners

Akram Hussain; Abid Saleem; Mir Yasir; Adil Hafeez Wani; Mir Mohsin; Umer Farooq

doi:10.18203/2320-6012.ijrms20163285

Authors

Akram Hussain Department of Plastic and Reconstructive Surgery, SKIMS, Soura, Srinagar, Jammu and Kashmir
Abid Saleem Department of Plastic and Reconstructive Surgery, SKIMS, Soura, Srinagar, Jammu and Kashmir
Mir Yasir Department of Plastic and Reconstructive Surgery, SKIMS, Soura, Srinagar, Jammu and Kashmir
Adil Hafeez Wani Department of Plastic and Reconstructive Surgery, SKIMS, Soura, Srinagar, Jammu and Kashmir
Mir Mohsin Department of Plastic and Reconstructive Surgery, SKIMS, Soura, Srinagar, Jammu and Kashmir
Umer Farooq Department of Plastic and Reconstructive Surgery, SKIMS, Soura, Srinagar, Jammu and Kashmir

DOI:

https://doi.org/10.18203/2320-6012.ijrms20163285

Keywords:

Thumb reconstruction, FDMA flap, Traumatic thumb

Abstract

Background: Thumb alone constitutes about 40% of hand function and trauma to distal part of thumb will thus affect the overall hand function. The goals of correction of traumatic deformities of distal thumb are to maintain adequate length and sensation along with giving a supple and stable soft tissue cover. Among other options, first dorsal metacarpal artery (FDMA) flap raised from the dorsum of the proximal part of index finger is a simple and widely used flap.

Methods: We compared the results of FDMA flap done by residents (M.Ch trainees) and consultants in our institute. Residents operated upon a total of 12 patients and consultants operated upon 16 patients.

Results: Among 12 patients operated by residents 3 flaps were lost and 2 flaps had marginal necrosis whereas among the patients operated by consultants 1 flap was lost and 1 had partial necrosis in distal part of the flap.

Conclusions: Although there was no statistical difference between the operating time taken by trainees and consultant specialists but the complication rate is higher among the residents. Sticking with the basics of plastic surgery, FDMA flap is an excellent technique for thumb reconstruction and results are excellent as and when more experience is gained.

Metrics

Metrics Loading ...

References

Hands NJ. Princeton, NJ, Princeton University Presss; 1993.

Ray E, Sherman R, Stevanovic M. Immediate reconstruction of a nonreplantable thumb amputation by great toe transfer: Plast Reconstr Surg. 2009;123(1):259-67.

Karaca K, Etöz A, Akın S. Racked-shaped kite flap. Eur J Gen Med. 2005;2(2):138-9.

Arakaki A, Tsai TM. Thumb replantation: Survival factors and re-exploration in 122 cases. J Hand Surg. 1993;18B:152-6.

Hilgenfeldt O. Operativer daumenersatz. Stuttgart: Enke-Verlag; 1950.

Holevich J. A new method of restoring sensibility to the thumb. J Bone Joint Surg. 1963;45B:496-502.

Foucher G, Braun J-B. A new island flap transfer from the dorsum of the index to the thumb. Plast Reconstr Surg. 1979;63:344-9.

Tränkle M, Sauerbier M, Heitmann C, Germann G. Restoration of thumb sensibility with the innervated first dorsal metacarpal artery island flap. J Hand Surg. 2003;28A:758-66.

Lai CH, Lai CS, Huang SH, Lin SD, Chang KP. Free medial plantar artery perforator flaps for resurfacing of thumb defects. Ann Plast Surg. 2010;65(6):535-40.

Hietmann C, Levin LS. Alternatives to thumb reimplantation. Plast Reconstr Surg. 2002;110(6):1492-503.

Makkar RM, Naemm W, Naeem J, Nabil TM. The Innervated 1st dorsal metacarpal artery island flap for reconstruction of post-traumatic thumb defect. Egypt. J Plast Reconstr Surg. 2012;36(2):147-52.