1ST DORSAL METACARPAL ARTERY FLAP: A RELIABLE OPTION TO RECONSTRUCT THE SOFT TISSUE DEFECT OF THE THUMB

Dr. Hasan Nazir Uddin*, Dr. Sharmin Akter Sumi, Dr. Md. Joynal Abeden, Dr. Md. Abul Kalam and Dr. Md. Mamun Or Rasheed

ABSTRACT

Background: The 1st Dorsal Metacarpal Artery (FDMA) Flap or Kite flap is a proximally based island flap based on the first dorsal metacarpal artery and it’s veins. A branch of radial sensory nerve is incorporated in the flap to make it a sensate flap. The aim of this study was to evaluate the 30 FDMA flaps done over a period of 9 month for distal thumb soft tissue defects. Materials and Methods: This is an observational study carried out on 30 patients with soft tissue loss on the Thumb who presented between the time of January 2019 to September 2019 in the Department of Plastic surgery, Dhaka Medical College Hospital. A thorough history was taken from the patient and their attendants. The wounds were examined preoperatively to assess the nature, examine the underlying structure and evaluate the appropriateness of the plan. All patients had laboratory tests required for surgery under anesthesia done. Results: Maximum patients (15) are in the age group of 21-30 years. Mean age is 26.17. 28 cases are male and male female ratio is 14:1. Regarding the cause of injury is Burn in 16 cases and trauma in 14 Patients. The mean length of flap is 28.20 mm and width is 15.57 mm. The results in all the cases are excellent except for four cases; one of which has marginal necrosis, and the other three has epidermal necrosis which healed without any surgical intervention. The FDMA flap is a reliable flap for thumb soft tissue coverage. 1st Web space span is excellent in 29 cases. Thumb movement in IP is excellent in 70% cases and in MP 96.67% is excellent. Donor sites are cover by full thickness skin graft in 27 cases, split thickness skin graft in two cases and fillet flap from middle finger in one case without any complication. Conclusion: The FDMA flap is a Reliable flap to reconstruct the Soft Tissue Defect of the Thumb. The flap is sensate, durable, provides adequate soft tissue coverage.

Keywords: 1st Dorsal Metacarpal Artery (FDMA), Flap, Thumb reconstruction, Sensate Flap, Island Flap for Thumb.