[Delayed DMCA-flap in a case of infection in the finger]
1Abteilung für Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover. christianherold@gmx.de
Introduction:
After its first description 1990 by Maruyama, the DMCA flap has been used for several indications. In 1999 Pelissier published his "extended DMCA flap" with a wider arc of rotation. Compared to the most frequent indications for the DMCA flap, palmar digital soft tissue defects after infection are rare.
Case Report:
A 35-year-old male stockman presented with a severe phlegmonous infection of the middle finger. Repeated debridements led to a soft tissue defect on the palmar side of the middle finger. After vain initial attempts the patient quit smoking and the DMCA II and III could be detected by ultrasonic Doppler probe. An extended DMCA II flap was performed to cover the soft tissue defect. Due to acute intraoperative ischaemia of the flap after elevation and rotation, the flap was repositioned to the donor site. After preconditioning for ten days, the transposition of the flap could be performed without any further problems. There were no postoperative complications. The length and the form of the finger could be preserved.
Conclusion:
Even in the case of palmar soft-tissue defects due to infections, the expanded DMCA flap may be a valuable option for coverage. It may be possible to localise the dorsal metacarpal arteries by ultrasonic Doppler probe in a smoking patient after a period time of nicotine abstinence, if initial attempts at detection fail. If the perfusion of the rotated extended DMCA flap appears to be compromised, we recommend the repositioning of the flap. Its transposition may be safely performed after a preconditioning period.
