Dorsal Metacarpal Artery Flaps with Extensor Indices Tendons for Reconstruction of Digital Defects

Introduction: Distally based dorsal metacarpal artery (DMCA) flaps are an established technique for the reconstruction of extensive finger defects. In many cases, such defects also include an injury of the extension tendon over the proximal and distal finger joint, which can lead to a reduced range of motion or finger deformation such as boutonniere deformity. To prevent this, operative techniques are necessary that allow complete defect coverage while simultaneously stabilizing the extension apparatus. Methods: In two cases, DMCA flaps were combined with vascularized extensor indices tendons for the reconstruction of extensive dorsal finger skin and soft tissue defects, particularly when tendon and bone are exposed. Results: After three weeks of postoperative immobilization, physiotherapy could be intensified. In a six months' follow-up, the results obtained from the standpoint of both function and appearance were excellent, the flaps remained viable at all times and full-finger length and sensory function were maintained. Regarding operation time, pain and finger appearance, both patients stated satisfaction. Conclusion: The vascularized tendon incorporated in DMCA flaps provides a sufficient method to restore a satisfactory finger function and prevent finger deformity, arthrodesis, or amputation, especially in cases with severe injuries of the extension apparatus.