Treatment of complex soft-tissue defects at the metacarpophalangeal joint of the thumb using the bilobed second dorsal metacarpal artery-based island flap.

Background: The purpose of this study is to report on reconstruction of complex soft-tissue defects around the metacarpophalangeal joint of the thumb using a bilobed second dorsal metacarpal artery-based island flap taken from the dorsum of the proximal phalanges of the index and long fingers.

Methods: From March of 2007 to October of 2009, the bilobed second dorsal metacarpal artery-based island flap was transferred in 13 patients. There were two defects on the metacarpophalangeal joint of the thumb.

The use of a third metacarpal base osteoarticular flap for treatment of metacarpophalangeal joint traumatic defects.

Purpose: To describe the use of a pedicled osteoarticular flap harvested from the base of the third metacarpal for the treatment of traumatic defects of the metacarpophalangeal (MCP) joints.

Methods: From February 2006 to January 2008, we included in the study 15 patients with posttraumatic defects of the MCP joints. The mean age of the patients was 35 years.

Osteoarticular pedicle flap from the capitate to reconstruct traumatic defects in the head of the proximal phalanx.

Purpose: To describe the reconstruction of traumatic defects in the head of the proximal phalanx using an osteoarticular pedicle flap from the capitate.

Methods: From January 2004 to December 2007, we treated 15 patients with traumatic defects of the head of the proximal phalanx at our institution. All of these injuries involved 1 condyle of the proximal phalanx.

Treatment of a Bennett fracture using tension band wiring.

Purpose: To describe and assess a tension band wiring technique for the treatment of Bennett fractures and to compare this technique of open reduction and internal fixation versus closed reduction and percutaneous pinning.

Methods: From July 2005 to April 2008, we treated 56 Bennett fractures in 56 patients using tension band wiring. The mean age of the patients was 32 years.

Coverage of dorsal-ulnar hand wounds with a reverse second dorsal metacarpal artery flap.

This article introduces the use of a modified reverse dorsal hand flap harvested from the radial portion of the dorsal hand and wrist and the distal portion of the dorsal forearm for reconstruction of a large defect involving the third to fifth metacarpophalangeal (MCP) joints and the proximal phalanges. From May 2005 to August 2008, a modified reverse dorsal hand flap was transferred in 12 hands in 12 patients (9 male and 3 female). The mean age at flap transfer was 34.

Use of the second dorsal metacarpal artery-based bilobed island flap for thumb reconstruction.

We report the use of the second dorsal metacarpal artery-based bilobed island flap harvested from the index and middle fingers for thumb reconstruction. From October 2006 to March 2008, the flap was performed in 13 hands in 13 patients (10 males and 3 females). The mean age at the time of operation was 45 years (range, 38 to 57 years).

Reconstruction of thumb pulp defects using a modified kite flap.

Purpose: We report on a modified kite flap for the reconstruction of thumb pulp defects. We performed nerve repair to improve thumb pulp sensation.

Methods: From May 2005 to December 2008, 42 thumbs in 42 patients were treated.

Use of a bilobed second dorsal metacarpal artery-based island flap for thumb replantation.

Purpose: An extensive traumatic defect at the level of the proximal phalanx of the thumb presents difficulty in replantation. We report bilobed second dorsal metacarpal artery-based island flap harvested from both the index and middle fingers for reconstruction of the defect and preservation of the normal thumb length.

Methods: From March 2004 to October 2008, 15 patients (11 men and 4 women; mean age, 35 y; range, 18 to 55 y) with completely or incompletely amputated thumbs associated with extensive defects in the proximal phalanx had replantation and reconstruction.

Reconstruction of circulation in the fingertip without vein repair in zone I replantation.

Purpose: In fingertip replantation, adequate venous drainage is important for success. As the level of amputation becomes more distal, anastomosis of veins becomes more technically difficult. External bleeding is a common solution to venous congestion, but the process is burdensome because of duration of bleeding for 3 or more days after surgery.

Posterior tibial artery-based multilobar combined flap free transfer for repair of complex soft tissue defects.

In this report, the posterior tibial artery (PTA) based multilobar combined flap is introduced for the repair of complex soft tissue defects. The flap was designed based on the perforatoring branches of PTA in the anterior soleus muscle septum, which supply the skin over the medial side of the calf and the entire soleus muscle. The saphenous nerve was included in one perforator flap of the combined flap for reinnervation.

Use of flap based on anterior tibial artery for free transfer.

Free flap transfer can be a challenge because of the risk of anastomotic failure, especially in microvascular tissue transfers. Free lateral crural flap based on the anterior tibial artery has good vascular condition that results in a low rate of failure. To avoid loss of the anterior tibial artery of the donor, we reconstructed the anterior tibial artery after the flap was harvested with a "half-half" technique in a simple way.

Use of flap based on posterior tibial artery for free transfer.

Free flap transfer can be a challenge because of the risk of anastomotic failure, especially in microvascular tissue transfers. Although free medial crural flap based on posterior tibial artery has many advantages and a high survival rate, the flap is now performed with decreasing frequency for transfer because of the sacrifice of one of the main arteries in the calf. To overcome this disadvantage, arterial reconstruction has been developed and is already in use in clinical cases.