Reversed dorsal digital and metacarpal island flaps supplied by the dorsalcutaneous branches of the palmar digital artery

The dorsal digital and metacarpal island flaps have been described for use in a variety of clinical situations. On the basis of the authors' previous angiographic studies, these two skin flaps were planned on the dorsum of th e proximal phalanx or intermetacarpal space based on the vascular anastomos es between the proximal dorsal cutaneous branches of the palmar digital art ery and the dorsal digital branches of the dorsal metacarpal artery at the level of the proximal phalanx. The authors present a series of 13 patients using these flaps. To reconstruct the injured finger pulp, the reverse dors al digital flap was used in 5 patients, and the reverse dorsal metacarpal f lap was used in 8 patients. Most of the 13 patients sustained a work-relate d injury. Associated injuries of bone, joint, or tendon occurred in most pa tients. In all patients, the skin defect was located distal to the proximal interphalangeal joint. The skin paddle was taken from the dorsal aspect of the middle and ring fingers or the first, second, third, and fourth metaca rpal area. All flaps survived completely. Two patients who had the dorsal b ranch of the sensitive radial nerve anastomosed to the digital nerve recove red 6-mm two-point discrimination in the reverse dorsal digital flap. The r esults of this anatomic study and the authors' clinical experience confirm the reliability of the dorsal digital and metacarpal island flaps.