Dorsal metacarpal artery perforator flaps for traumatic soft tissue defect of finger: A prospective anatomical and clinical study.

Purpose: Anatomical studies provide the foundation for surgical advancements, particularly in perforator-based procedures. Despite safety measures, hand injuries continue to occur, making reconstructive surgery essential for improving quality of life. Magnification techniques have transformed plastic surgery, aiding perforator-based surgeries and improving outcomes. This study aims to bridge the gap in anatomical knowledge and explore the potential benefits of dorsal metacarpal artery flap.

Methods: This prospective study, conducted from July 2021 to June 2023, focused on the dorsal metacarpal artery perforators in fresh frozen cadavers. Fresh un-embalmed cadavers without signs of trauma or deformity to the upper limb were included. The anatomical study comprised the process of injecting red latex into the arteries located at the wrist, followed by dissection and measurements of number of perforators, calibre, distance of perforators from metacarpal head and radial styloid. In the clinical phase, hand held doppler was used to locate the perforators of the metacarpal arteries between metacarpal heads. Based on these perforators, flaps were raised for the patients with defects over the proximal fingers. Details about defect, flap and patients characteristics were tabulated and presented.

Results: The study was carried out on 6 fresh frozen cadavers (12 hands). Anatomical findings revealed the anatomical location, calibre, and consistent number of metacarpal artery perforators and dorsal carpal artery perforators supplying the dorsum of the hand. There was one perforator from 1st, 2nd, and 3rd metacarpal arteries. More than on perforators were found originating from 4th and 5th metacarpal arteries. Perforator of 1st metacarpal artery was largest in size (1.23 ± 0.27) mm. The study included 25 patients with finger defects. Metacarpal artery perforator flaps were planned to cover these defects. Successful outcome were achieved in 92% of patients.

Conclusion: Perforator-based flaps are effective for small to medium-sized hand defects, reducing the need for distant pedicled flaps. These flaps provide functional and aesthetic benefits while minimizing donor site complications. The unique anatomical insights from our study include the consistent number and location of dorsal metacarpal artery perforators, as well as their relation to key landmarks such as the juncturae tendineae and 2 bony prominences (first metacarpal head and radial styloid process).