The use of the dorsal metacarpal artery for reconstruction of distal dorsal finger defects: an anatomic study and clinical experience

Abstract

Purpose: Dorsal metacarpal artery (DMA) flaps have been successfully used for distal dorsal finger defects. Some studies have reported inconsistent DMA anatomy, and there have been no studies on the anatomic variation of DMAs in Asian cadavers. Therefore, we evaluated the anatomy of the DMA using Korean fresh cadavers and reported the clinical outcomes of the DMA flaps.

Methods: In this cadaveric study, four human forearms from adult fresh cadavers were dissected. The dorsal metacarpal arteries and their communicating branches were identified. From July 2016 to June 2019, five patients with dorsal finger defects underwent a first DMA (FDMA) flap or a reverse DMA (RDMA) flap.

Results: In our cadaver study, the ulnar branch of the FDMA and the second and third DMAs were absent in two of four (50%) of the cadavers. In our case series, five flaps survived, and one had partial necrosis, which healed by the second intention. The mean operation time was approximately 100 minutes, and the mean outpatient follow-up period was 6 months.

Conclusion: DMA flaps are for the reconstruction of relatively large soft tissue defects of the dorsal finger. However, our anatomical study identified inconsistencies in the anatomy of DMAs. Therefore, a preoperative Doppler examination is required to evaluate the anatomy of the DMA before considering the use of a DMA flap.