Background and objective

Skin of the dorsal aspect of the hand and fingers is thin and fragile when exposed to mechanical or thermal trauma. In gripping gestures contact with close objects ends in full thickness skin injuries and damage to underlying structures.

Maximum elasticity on the back of the joints adds properties that are difficult to replace when the skin cover of the first finger needs to be replaced

We considerer that the first dorsal metacarpal artery flap (PAMD), described by Foucher in 1979, is a very good alternative in these cases as it is a neurovascularizad flap, with simple and reliable dissection

Methods

This study presents a series of 6 patients affected with acute thumb lesions or post-burn scars contracture, repaired with this flap with a description of the technique and complementary measures for immobilization and coverage.

Results

All the patients presented improvement or cure; half suffered venous congestion 24 hours after surgery with subsequent epidermolysis and full recovery without necrosis or wound dehiscence. All the grafts used to cover the donor area take and mobility was preserved. The PAMD flap showed preserved sensitivity with mild hyperalgesia the first 30 days.

In the pedicle we observed in all cases the vasa-nervorum of the radial branch. In 3 cases the PAMD artery was not an independent flap structure, observing other branches included in the fascia. In 1 case the artery was subfascial and in 2 suprafascial

Conclusion

We recommend the use of the PAMD flap in this type of injury, as an island flap in the volar region and as a peninsula flap in the dorsal region, in order not to hinder venous return

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