The innervated first dorsal metacarpal artery island flap
for reconstruction of post-traumatic thumb defect
Ramy Magdy Makkar
Received: 21 January 2012 / Accepted: 21 March 2012 / Published online: 28 April 2012
Background Various surgical techniques contribute to repair
distal defects of the fingers, especially the thumb as trau-
matic loss diminishes or eliminates the thumb prehensile
abilities and may affect overall hand function.
Methods Ten innervated first dorsal metacarpal artery
(FDMCA) island flaps were performed and evaluated post-
operatively. The function of the thumb and the cosmetic
appearance were documented for all patients.
Results The flap survived with good cosmetic results in all
cases. Grasping and pinching activity as well as cortical
orientation was achieved for all flaps.
Conclusion It appears that the FDMCA flap is one of the
best solutions for cover of simple or complex skin loss of
the thumb. Its technical performance is easy, and it gives
durable, sensate, and stable skin cover.
Level of Evidence: Level 4, therapeutic study.
Keywords Innervated first dorsal metacarpal artery island
Traumatic thumb injury presents a much more significant
influence on daily living than do injuries to the other digits
. The most common cause of injuries was blunt trauma
(50 %), followed by injuries from sharp object (25 %).
Traumatic tissue loss of pulp on the first finger represents
a common problem which requires serious reconstructive
The thumb is used in virtually all activities that involve
the arm and hand . Daily tasks involving pinch, grip,
grasp, and precision handling are more easily accomplished
with an opposable thumb . The unique features of the
human hand can be viewed as adaptations for throwing and
Coverage of soft tissue on the fingers may be difficult
due to the size of the defect or the limitation of local flap
mobilization. Moreover, exposure of the deep structures
(complex defects) such as joint, bones, or tendons is an
emergency that requires a reliable technique for coverage
. Restoration of sensibility after traumatic loss of the
palmar aspect of thumb is of utmost importance for the
usefulness of the hand .
Generally, these defects are closed by regional flaps
as: palmar advancement flap (Moberg), cross-finger flap,
neurovascular island flap (Littler), and the first dorsal
metacarpal artery flap . More recently, various micro-
surgical free flaps from the first and second toe and web
space of the foot were described as alternative solutions for
this problem. All free flaps require coaptation of their
sensory nerves in the recipient area. This limits their
use in older patients in whom re-innervation may yield
poor results , and success of this procedure is not always
guaranteed . The advantages of the innervated first
dorsal metacarpal artery (FDMCA) island flap from the
dorsum of the index finger which was first described by
Hilgenfeldt  refined by Hollevich  and modified as a
pure island flap by Foucher and Braun  are its variable
size, stability, pliability, and the innervated skin with no major
donor site morbidity .
R. M. Makkar (*)
Department of Surgery, Cairo University,
Eur J Plast Surg (2012) 35:881–886