[Dorsal metacarpal flap with an extensive retrograde pedicle. Anatomic study and 22 clinical cases]

The dorsal digitometacarpal flap or extended distal pedicled dorsal metacarpal flap is a new skin flap, useful in reconstructing large distal defects on the dorsal aspect of the digits. It is raised on the dorsum of the hand, over an intermetacarpal space. Its vascularisation is provided by proximal dorsal cutaneous branches of the digital collateral arteries through the rich, anastomotic arterial network of the webspace. This flap is a useful flap compared to others flaps harvested from the dorsum of the hand, such as the reverse metacarpal flaps. The operative procedure preserves the dorsal interosseous muscles aponeurosis, the junctura tendinum and the dorsal metacarpal artery. Its vascularisation depends on the webspace arterial network; it is constant contrary to the dorsal metacarpal arteries of the ulnar spaces. This flap is indicated to cover distal defects on the dorsum of the digits because of its large rotation arc. The anatomical basis and operative technique of the flap are described. Two out of 22 clinical cases were selected to illustrate the ability of this flap for reconstruction of digital defects.