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BY-NC-ND 3.0 license Open Access Published by De Gruyter Open Access April 17, 2010

The use of reverse-flow dorsal metacarpal artery flaps after postburn metacarpophalangeal joint flexion contracture release

  • Haluk Duman EMAIL logo , Fatih Uygur and Rahmi Evinç
From the journal Open Medicine


When thermal injuries of the hand are managed inappropriately, complex hand contractures are inevitable. Patients with hand contractures may have many difficulties in their daily life because of this deformity. These patients are challenging to reconstructive surgeons. In this study we evaluated reverse-flow dorsal metacarpal artery flaps for the defects occurred after metacarpophalangeal joint contracture release of different fingers. Nineteen patients with defects on the volar surface of metacarpophalangeal joint were reconstructed by the reverse-flow dorsal metacarpal artery flaps. All operations were successful and flap losses were not seen. The DMCA flaps provide one stage coverage and permit primary closure of the recipient site. The aesthetic and functional results are satisfactory without sacrificing main arteries. The only drawback is the residual scar on the dorsum of the hand, which can be treated by conservative means and may improve over time.

[1] Huang T., Management of contractural deformities involving the axilla, elbow, hip, and knee joints in burned patients, Total Burn Care, Saunders Elsevier, 2007, 727–740 10.1016/B978-1-4160-3274-8.50059-3Search in Google Scholar

[2] Cronin T.D., The cross-finger flap. A new method of repair, Am. Surg., 1951, 17, 419–25 Search in Google Scholar

[3] Foucher G.D., Braun J.B., A new island flap transfer from the dorsum of the index to the thumb, Plast. Reconstr. Surg., 1979, 63, 344–9 in Google Scholar

[4] Acikel C., Peker F., Yuksel F., Bilateral side finger transposition flaps in the treatment of chronic postburn flexion contractures of the fingers, Ann. Plast. Surg., 2002, 49, 344–9 in Google Scholar

[5] Ulkur E., Uygur F., Karagoz H., Celikoz B., Flap Choices to Treat Complex Severe Postburn Hand Contracture, Ann. Plast. Surg., 2007, 58, 479–483 in Google Scholar

[6] Bostwick J., Briedis J., Jurkiewicz M.J., The reverse flow temporal artery island flap, Clin. Plast. Surg., 1976, 3, 441–445 10.1016/S0094-1298(20)30199-1Search in Google Scholar

[7] Earleyy M., Milner R., Dorsal metacarpal flaps., Br. J. Plast. Surg., 1987, 40, 333–41 in Google Scholar

[8] Dautel G., Merle M., Dorsal metacarpal reverse flaps. Anatomical basis and clinical application, J. Hand Surg., 1991, 16, 400–5 10.1016/0266-7681(91)90012-DSearch in Google Scholar

[9] Maryuama Y., The reverse dorsal metacarpal flap., Br. J. Plast. Surg., 1990, 43, 24–7 in Google Scholar

[10] Germann G., Funk H., Bickert B., The fate of the dorsal metacarpal arterial system following thermal injury to the dorsal hand: A doppler sonographic study, J. Hand Surg., 2000, 25, 962–8 in Google Scholar PubMed

[11] Pelissier P., Casoli V., Backhach J., Martin D., Baudet J., Reverse dorsal digital and metacarpal flaps: a review of 27 cases, Plast. Reconstr. Surg., 1999, 103, 159–65 in Google Scholar PubMed

[12] Yang D., Morris S.F., Reversed dorsal digital and metacarpal island flaps supplied by the dorsal cutaneous branches of the palmar digital artery, Ann. Plast. Surg., 2001, 46, 444–9 in Google Scholar

[13] Harrison D.H., Newton J., Two flaps to resurface the basal flexion-crease of the finger area, J. Hand Surg. (Br)., 1991, 16, 78–83 10.1016/0266-7681(91)90135-BSearch in Google Scholar

[14] Ulkur E., Uygur F., Karagöz H., Celiköz B., Use of free dorsoulnar perforator flap in the treatment of postburn contractures of the fingers Burns, 2006, 32, 770–5 in Google Scholar

[15] Uygur F., Duman H., Celiköz B., Use of free anterolateral thigh perforator flap in the treatment of chronic postburn palmar contractures, Burns, 2007, 34, 275–280 in Google Scholar

[16] Uygur F., Duman H., Ülkür E., Celiköz B., Chronic Postburn Palmar Contractures Reconstruction Using The Medial Pedis Perforator Flap, Ann. Plast. Surg. 2008, 61, 269–273 in Google Scholar

[17] Uygur F., Sever C., Evinç R., Ulkür E., Duman H. Reverse flow flap use in upper extremity burn contractures. Burns. 2008 Sep 18 [Epub ahead of print] 10.1016/j.burns.2008.05.019Search in Google Scholar

[18] Yousif N.J., Ye Z., Sanger J.R., Arria P., Gilbert A., Matloub H.S., The versatile metacarpal and reverse metacarpal artery flap in hand surgery, Ann. Plast. Surg., 1992, 29, 523–31. in Google Scholar

[19] Eski M., Nisanci M., Sengezer M., Correction of thumb deformities after burn: versatility of first dorsal metacarpal artery flap, Burns, 2007, 33, 65–71. in Google Scholar

[20] Yoon S.W., Rebecca A.M., Smith A.A., Mazaheri M.K., Casey W.J., Reverse second dorsal metacarpal artery flap for reconstruction of fourth-degree burn wounds of the hand, J. Burn Care Res., 2007, 28, 521–3 in Google Scholar

[21] Foucher G., Khouri R.K., Digital reconstruction with island flaps, Clin. Plast. Surg., 1997, 24, 1–32. 10.1016/S0094-1298(20)32579-7Search in Google Scholar

[22] Karamursel S, Celebioglu S. Reverse-flow first dorsal metacarpal artery flap for index fingertip reconstruction. Ann Plast Surg 2005;54: 600–603 in Google Scholar

[23] Woo S.H., Seul J.H., Optimizing the Correction of Severe Postburn Hand Deformities by Using Aggressive Contracture Releases and Fasciocutaneous Free-Tissue Transfers, Plast. Reconstr. Surg., 2001, 107, 1–8 in Google Scholar

[24] Small J.O., Brennan M.D., The first dorsal metacarpal artery neurovascularisland flap, J. Hand Surg. Br., 1988, 13, 136–145 in Google Scholar

[25] Arria P., Gilbert A., Dorsal interosseous arteries of the hand. In: Gilbert A, Masquelet AC, Hentz R, editors. Pedicled flaps of the upper limb. Vascular Anatomy, Surgical Technique and Current Indications, London, Martin Dunitz, 1992, 155–68 Search in Google Scholar

[26] Gelbermann R.H., Panagis J.S., Taleisnik J., Baumgaertner M., The arterial anatomy of the human carpus. Part I. The extraosseous vascularity, J. Hand Surg., 1983, 8, 367–75. 10.1016/S0363-5023(83)80194-4Search in Google Scholar

[27] Gregory H., Heitmann C., Germann G., The evolution and refinements of the distally based dorsal metacarpal artery (DMCA) flaps, J. Plast. Reconstr. Aesht. Surg., 2007, 60, 731–739 in Google Scholar PubMed

[28] Olave E., Prates J.C., Grabrielle C., Mandiola E., Perforating branches: Important contribution to the formation of the dorsal metacarpal arteries, Scand. J. Plast. Recontr. Hand Surg., 1997, 32, 221–7 10.1080/02844319850158859Search in Google Scholar PubMed

Published Online: 2010-4-17
Published in Print: 2010-4-1

© 2008 Versita Warsaw

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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