Thumb Reconstruction Using Foucherâ€™s Flap
BACKGROUND: Extensive pulp defects of the thumb, with the exposure of tendon or bone, are challenging reconstructive problems. Surgical treatment includes the use of local, regional, and free flaps.
AIM: This paper is focused in Foucherâ€™s neuro vascular flap. First DMCA or Foucherâ€™s pedicle flap is a successful thumb reconstruction method, especially in patients not disturbed by its cosmetic appearance.
MATERIAL AND METHODS: The first dorsal metacarpal artery (FDMCA) arises from the radial artery in the first intermetacarpal space, just distal to the tendon of the extensor pollicis longus. Pulp area of the thumb is the area where Foucherâ€™s flap is more utilizable. This technique has other applications such as first web reconstruction, thumb lengthening, and following resection of tumors on the dorsum of the hand.
RESLTS: We have in study 7 cases with work related trauma in two years period of time, between 2012 and 2014. We had only one partial flap survival and all the other flaps survived entirely. We have also taken in consideration subjective satisfaction with a range score from 4 to 10, cold intolerance, flap area and donor site sensibility with a range score from low to medium to normal.CONCLUSION: Careful pedicle discovery, secured elevation, pedicle strangulation prevention are very important for flap survival.
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Muyldermans T, Hielmer R. First dorsal metacarpal artery flap for thumb reconstruction; a retrospective clinical study. Strategies Trauma Limb Reconst. 2009;4(1);27â€33.
de Rezende MR, Mattar JÃºnior R, Cho AB, Hasegawa OH, Ribak S. Anatomic study of the dorsal arterial system of the hand. Rev Hosp Clin Fac Med Sao Paulo. 2004 ;59(2):71-6.
Shun-Cheng C, Shao-Liang C, Tim-Mo C, Chia-Jueng C, Tian-Yeu C, Hsian-Jenn W. Sensate first dorsal metacarpal artery flap for resurfacing extensive pulp defects of the thumb. Ann Plast Surg. 2004; 53(5):449â€“454.
TrÃ¤nkle M, Sauerbier M, Heitmann C, Germann G. Restoration of thumb sensibility with the innervated first dorsal metacarpal artery island flap. J Hand Surg [Am]. 2003;28(5):758â€“766.
Sherif MM. First dorsal metacarpal artery flap in hand reconstruction. II. Clinical application. J Hand Surg. 1994;19A:26â€“31.
Foucher G, Braun JB. A new island flap transfer from the dorsum of the index to the thumb. Plast Reconstr Surg.1979;63:344â€“9.
Elâ€Khatib HA. Clinical experiences with extended first dorsal metacarpal artery island flap for thumb reconstruction. J Hand Surge Am. 1998;23:647â€“52.
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