[First dorsal metacarpal flap in compound multi tissues thumb reconstruction]

In the years 1985-2000 two females and eleven males aged 3-48 (mean age 27) were treated using neurovascular first dorsal metacarpal flap because of compound thumb multi-tissue defects. In two cases the flap included a fragment of vascularized bone from the index proximal phalanx. Simultaneously a graft of non-vascularized bone in three cases, nerve grafts in two cases and a reconstruction of A1 pulley of the FPL tendon in three cases were carried out. Two patients were operated immediately after the injury and the others had delayed reconstructions. In 6 cases the defects resulted from crushing or lacerated wounds of the proximal thumb and in three cases of the distal thumb. Three thumbs were distally amputated. A 3 year-old child had an extensive palmar tissues necrosis due to an electric burn. Pedicled flaps were used in twelve patients and one patient had an island flap. The flaps ranged from 2.24 to 12.0 square centimetres. The donor wounds were directly closed in 6 patients and in 7 patients they were skin grafted. All flaps survived completely resulting in good function. Vascularized bone grafts raised in the flaps healed after 6 and 10 weeks respectively, those non-vascularized from the olecranon healed after 8 weeks and all were further rebuilt giving strong thumb of proper length. 2PD was 8-10 mm. Reconstruction of the sheath elements with flap tissues successfully supported FPL tendon. None of the donor site were observed.