Abstract
Purpose
Reconstruction of the thumb with exposure of bone and tendon is challenging. We designed a bipedicle island flap from the dorsum of the index finger to repair thumb defects. One pedicle includes the radial proper palmar digital artery (PDA) of the index finger, another pedicle includes the first dorsal metacarpal artery (FDMA). The aim of the study was to investigate the anatomical basis and clinical application of this flap.
Methods
Eleven fresh cadaver hands were dissected, the FDMA and the radial proper PDA were exposed. Their origin, distribution and diameter in different locations, especially in the dorsum of the proximal phalanx of the index finger, were examined. Ten patients (11 hands) underwent thumb reconstruction using this flap. During follow-up, the flap survival and hand function were evaluated.
Results
The origin of the FDMA in three cadaver hands was abnormal. The FDMA was mainly distributed in the proximal area of the dorsum of the proximal phalanx. The radial proper PDA of the index finger formed one constant dorsal branch, mainly distributing in the middle and distal area of the dorsum of the proximal phalanx. All flaps survived. At follow-up, the span of the first web and the range of motion of the thumbs and index fingers reached more than 94 % of the contralateral finger. All patients were satisfied with the hand function according to the Michigan Hand Outcomes Questionnaire (MHQ).
Conclusions
The bipedicle island flap has two arterial systems to provide sufficient blood supply. This technique provides another option for thumb reconstruction when a large supercharged FDMA island flap needs to be designed, or when there is an additional injury to the radial side of the dorsum of the hand or if there are anatomical variations of the FDMA, or if damage to the FDMA occurs during surgery.
Similar content being viewed by others
References
Huang D, Wang HG, Wu WZ et al (2011) Functional and aesthetic results of immediate reconstruction of traumatic thumb defects by toe-to-thumb transplantation. Int Orthop 35(4):543–547
Vekris MD, Beris AE, Lykissas MG et al (2011) Index finger pollicization in the treatment of congenitally deficient thumb. Ann Plast Surg 66(2):137–142
Bang H, Kojima T, Hayashi H (1992) Palmar advancement flap with V-Y closure for thumb tip injuries. J Hand Surg Am 17(5):933–934
Harenberg PS, Jakubietz RG, Jakubietz MG et al (2012) Reconstruction of the thumb tip using palmar neurovascular flaps. Oper Orthop Traumatol 24(2):116–121
Megerle K, Palm-Bröking K, Germann G (2008) The cross-finger flap. Oper Orthop Traumatol 20(2):97–102
Zhang X, Yang L, Shao X et al (2011) Use of a bilobed second dorsal metacarpal artery-based island flap for thumb replantation. J Hand Surg Am 36(6):998–1006
Horta R, Barbosa R, Oliveira I et al (2009) Neurosensible reconstruction of the thumb in an emergency situation: review of 107 cases. Tech Hand Up Extrem Surg 13(2):85–89
Zhang X, Shao X, Ren C et al (2011) Reconstruction of thumb pulp defects using a modified kite flap. J Hand Surg Am 36(10):1597–1603
EL-Gammal TA, Wei FC (1997) Microvascular reconstruction of the distal digits by partial toe transfer. Clin Plast Surg 24(1):49–55
Coleman SS, Anson BJ (1961) Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obstet 113:409–424
Foucher G, Braun JB (1979) A new island flap transfer from the dorsum of the index to the thumb. Plast Reconstr Surg 63(3):344–349
Small JO, Brennen MD (1988) The first metacarpal artery neurovascular island flap. J Hand Surg Br 13(2):136–145
Yang JY (1991) The first dorsal metacarpal flap in first web space and thumb reconstruction. Ann Plast Surg 27(3):258–264
Muyldermans T, Hierner R (2009) First dorsal metacarpal artery flap for thumb reconstruction: a retrospective clinical study. Strategies Trauma Limb Reconstr 4(1):27–33
Delikonstantinou IP, Gravvanis AI, Dimitriou V et al (2011) Foucher first dorsal metacarpal artery flap versus littler heterodigital neurovascular flap in resurfacing thumb pulp loss defects. Ann Plast Surg 67(2):119–122
Chen C, Zhang X, Shao X et al (2010) Treatment of thumb tip degloving injury using the modified first dorsal metacarpal artery flap. J Hand Surg Am 35(10):1663–1670
Chang SC, Chen SL, Chen TM et al (2004) Sensate first dorsal metacarpal artery flap for resurfacing extensive pulp defects of the thumb. Ann Plast Surg 53(5):449–454
Gebhard B, Meissl G (1995) An extended first dorsal metacarpal artery neurovascular island flap. J Hand Surg Eur 20(4):529–531
Moschella F, Cordova A (2006) Reverse homodigital dorsal radial flap of the thumb. Plast Reconstr Surg 117(3):920–926
Gupta C, Ray B, Dsouza AS et al (2012) A morphological study of variations in the branching pattern and termination of the radial artery. Singap Med J 53(3):208–211
Zhang X, He Y, Shao X et al (2009) Second dorsal metacarpal artery flap from the dorsum of the middle finger for overage of volar thumb defect. J Hand Surg Am 34(8):1467–1473
Woon CY, Lee JY, Teoh LC (2008) Resurfacing hemipulp losses of the thumb: the cross finger flap revisited: indications, technical refinements, outcomes, and long-term neurosensory recovery. Ann Plast Surg 61(4):385–391
Hollevoet N, Kinnen L, Moermans JP et al (1996) Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint of the thumb. J Hand Surg Br 21(4):458–462
Chung KC, Pillsbury MS, Walters MR et al (1998) Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am 23(4):575–587
Muyldermans T, Hierner R (2009) First dorsal metacarpal artery flap for thumb reconstruction: a retrospective clinical study. Strategies Trauma Limb Reconstr 4(1):27–33
Paneva-Holevich E, Holevich Y (1991) Further experience with the bipedicled neurovascular island flap in thumb reconstruction. J Hand Surg Am 16(4):594–597
Xarchas KC, Tilkeridis KE, Pelekas SI et al (2008) Littler’s flap revisited: an anatomic study, literature review, and clinical experience in the reconstruction of large thumb-pulp defects. Med Sci Monit 14(11):CR568–CR573
Lassner F, Becker M, Berger A et al (2002) Sensory reconstruction of the fingertip using the bilaterally innervated sensory cross-finger flap. Plast Reconstr Surg 109(3):988–993
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
H. Tan and D. Tan contributed equally to this work.
Rights and permissions
About this article
Cite this article
Tan, Hl., Tan, Dy. & Zhao, Jk. Treatment of thumb soft-tissue defects using a bipedicle island flap of the index finger: anatomical basis and clinical application. Arch Orthop Trauma Surg 133, 721–728 (2013). https://doi.org/10.1007/s00402-013-1704-y
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-013-1704-y