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The second dorsal metacarpal artery chain-link flap: an anatomical study and a case report

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Abstract

Purpose

The purpose of this study was to discuss the distribution characteristics and the anatomical angioarchitecture of cutaneous branches arising from the second dorsal metacarpal artery for the repair of small tissue defects in the hand or fingers using the second dorsal metacarpal artery chain-link flap.

Methods

Fifteen fresh human cadaveric hands were studied using three methods: latex perfusion for microanatomical analysis, denaturation of material and vinyl chloride mixed packing for cast specimens, and latex perfusion creating pellucid specimens. Cutaneous perforators with a diameter of 0.2 mm or greater were evaluated using statistical analysis. Cluster analysis was conducted to determine the overall distribution of the perforators.

Results

Two main clusters of perforators distributed at a relative distance of 40.8 and 68.6 % from the second web space edge to the midpoint of the second metacarpal bone as a unit. The Chi-square analysis revealed no significant differences in either the radial or ulnar side distribution of the cutaneous perforators from the second dorsal metacarpal artery (p = 0.779). Chain-links formed among adjacent perforators were parallel to the axis of the second metacarpal bone on the dorsum of the hand. Based on the anatomic characteristic, we designed the second dorsal metacarpal artery chain-link flap to recover the defect in the index finger. As a result, the patient was satisfied with the appearance and function.

Conclusion

This study indicates that there are two main clusters of arterioles in the distal second dorsal metacarpal artery that can be helpful for the second dorsal metacarpal artery pedicle cutaneous chain-link perforator flaps in the repair of defects in the fingers.

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References

  1. Aldabagh B, Cook JL (2014) Reconstruction of scalp wounds with exposed calvarium using a local flap and a split-thickness skin graft: case series of 20 patients. Dermatol Surg 40:257–265

    Article  CAS  PubMed  Google Scholar 

  2. Bailey SH, Andry D, Saint-Cyr M (2010) The dorsal metacarpal artery perforator flap: a case report utilizing a Quaba flap harvested from a previously skin-grafted area for dorsal 5th digit coverage. Hand (N Y) 5:322–325

    Article  Google Scholar 

  3. Checcucci G, Galeano M, Zucchini M, Zampetti PG, Ceruso M (2013) Reverse flow first dorsal metacarpal artery flap for covering the defect of distal thumb. Microsurgery 34:283–286

    Article  PubMed  Google Scholar 

  4. Chen C, Zhang W, Tang P (2013) Direct and reversed dorsal digito-metacarpal flaps: a review of 24 cases. Injury 45:805–812

    Article  PubMed  Google Scholar 

  5. Comert A, Altun S, Unlu RE, Orbay H, Tekdemir I (2011) Perforating arteries of the anteromedial aspect of the thigh: an anatomical study regarding anteromedial thigh flap. Surg Radiol Anat 33:241–247

    Article  PubMed  Google Scholar 

  6. Dautel G, Merle M (1992) Direct and reverse dorsal metacarpal flaps. Br J Plast Surg 45:123–130

    Article  CAS  PubMed  Google Scholar 

  7. Dautel G, Merle M (1991) Dorsal metacarpal reverse flaps. Anatomical basis and clinical application. J Hand Surg Br 16:400–405

    Article  CAS  PubMed  Google Scholar 

  8. Earley MJ, Milner RH (1987) Dorsal metacarpal flaps. Br J Plast Surg 40:333–341

    Article  CAS  PubMed  Google Scholar 

  9. Guo L, Pribaz JR, Pribaz JJ (2008) Nasal reconstruction with local flaps: a simple algorithm for management of small defects. Plast Reconstr Surg 122:130–139

    Article  Google Scholar 

  10. Hallock GG (2003) Direct and indirect perforator flaps: the history and the controversy. Plast Reconstr Surg 111:855–866

    Article  PubMed  Google Scholar 

  11. Karacalar A, Ozcan M (1997) A new approach to the reverse dorsal metacarpal artery flap. J Hand Surg Am 22:307–310

    Article  CAS  PubMed  Google Scholar 

  12. Lai-jin L, Xu G (2006) The reverse dorsal metacarpal flap: experience with 153 cases. Ann Plast Surg 56:614–617

    Article  PubMed  Google Scholar 

  13. Lai-Jin L, Xu G, Jian-Li C, Xi-Guang S (2008) A modified approach of the reverse dorsal metacarpal island flap: anatomical basis and application in 24 cases. Ann Plast Surg 61:392–395

    Article  PubMed  Google Scholar 

  14. Le Nen D, Rizzo C, Hu W, Gerard R, Oana D, Lefevre C, Senecail B (2009) The island hemisoleus flap on distal vascular pedicle: anatomical bases and clinical applications. Surg Radiol Anat 31:715–721

    Article  PubMed  Google Scholar 

  15. Mei J, Morris SF, Ji W, Li H, Zhou R, Tang M (2013) An anatomic study of the dorsal forearm perforator flaps. Surg Radiol Anat 35:695–700

    Article  PubMed  Google Scholar 

  16. Ozaksar K, Toros T, Sugun TS, Bal E, Ademoğlu Y, Kaplan I (2010) Reconstruction of finger pulp defects using homodigital dorsal middle phalangeal neurovascular advancement flap. J Hand Surg Eur 35:125–129

    Article  CAS  Google Scholar 

  17. Quaba AA, Davison PM (1990) The distally-based dorsal hand flap. Br J Plast Surg 43:28–39

    Article  CAS  PubMed  Google Scholar 

  18. Rozen WM, Niumsawatt V, Ross R, Leong JC, Ek EW (2013) The vascular basis of the hemi-hamate osteochondral free flap. Part 1: vascular anatomy and clinical correlation. Surg Radiol Anat 35:585–594

    Article  PubMed  Google Scholar 

  19. Schaverien M, Saint-Cyr M (2008) Perforators of the lower leg: analysis of perforator locations and clinical application for pedicled perforator flaps. Plast Reconstr Surg 122:161–170

    Article  CAS  PubMed  Google Scholar 

  20. Stecco C, Tiengo C, Stecco A, Porzionato A, Macchi V, Stern R, De Caro R (2013) Fascia redefined: anatomical features and technical relevance in fascial flap surgery. Surg Radiol Anat 35:369–376

    Article  PubMed  Google Scholar 

  21. Strauch B, Moura WJ (1990) Arterial system of the fingers. J Hand Surg Am 15:148–154

    Article  CAS  PubMed  Google Scholar 

  22. Sun C, Hou ZD, Wang B, Ding ZH (2013) An anatomical study on the characteristics of cutaneous branches-chain perforator flap with ulnar artery pedicle. Plast Reconstr Surg 131:329–336

    Article  CAS  PubMed  Google Scholar 

  23. Taylor GI, Palmer JH (1987) The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 40:113–141

    Article  CAS  PubMed  Google Scholar 

  24. Yang D, Morris SF (2001) Vascular basis of dorsal digital and metacarpal skin flaps. J Hand Surg Am 26:142–146

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This study was funded by Medical Scientific Research Fund Project in Guangdong Province in 2012 (Project No. A2012661).

Conflict of interest

The authors certify that there is no conflict of interest associated with this publication.

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Authors and Affiliations

  1. Department of Anatomy, Southern Medical University, Guangzhou, China

    Peng Liu

  2. Department of Anatomy, School of Basic Medical Science, Yan Bian University, Yanji, China

    Xiangzheng Qin

  3. Department of Biostatistics, Southern Medical University, Guangzhou, China

    Huifeng Zhang

  4. Department of Osteology of Zhujiang Hospital, Southern Medical University, Guangzhou, China

    Chao Sun

  5. Department of Hand and Foot Surgery, Luqiao Hospital of Taizhou Enze Medical Center, Taizhou, China

    Youmao Zheng

  6. Department of Osteology, The Third People’s Hospital, 1023 zhengxin Road, Nanhai District, Foshan, 528244, China

    Yafei Xu

  7. Department of Anatomy, Southern Medical University, 1023 Shatai South Road, Guangzhou, 510515, China

    Zihai Ding

Authors
  1. Peng Liu
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  2. Xiangzheng Qin
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  3. Huifeng Zhang
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  4. Chao Sun
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  5. Youmao Zheng
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  6. Yafei Xu
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  7. Zihai Ding
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Corresponding authors

Correspondence to Yafei Xu or Zihai Ding.

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Liu, P., Qin, X., Zhang, H. et al. The second dorsal metacarpal artery chain-link flap: an anatomical study and a case report. Surg Radiol Anat 37, 349–356 (2015). https://doi.org/10.1007/s00276-014-1372-9

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  • DOI: https://doi.org/10.1007/s00276-014-1372-9

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