[Repair of irregular wounds on thumbs and index fingers with first dorsal metacarpal artery-based pedicle dictyo-pattern sublobe flaps].

OBJECTIVE: To explore the effect of the first dorsal metacarpal artery-based pedicle dictyo-pattern sublobe flaps in repairing irregular wounds on thumbs and index fingers.

METHODS: From December 2006 to March 2009, 15 patients with irregular wounds on thumbs and index fingers were treated, including 11 males and 4 females, with an average age of 31 years (range, 18-48 years). Of them, 6 cases of hyperplastic scar of postburn had a 2-25 years course of disease (7.5 years on average) and 9 cases of machine injury had a 14-30 days course of disease (20 days on average). In 8 thumb wounds on palmaris, there were 3 cases of rhomboid wounds, 1 case of C-shape wound, and 4 cases of irregular wounds; the area of wounds ranged from 4.5 cm x 3.0 cm to 5.5 cm x 4.5 cm and wounds were treated by the first dorsal metacarpal artery-based proximate pedicle dictyo-pattern sublobe flaps (5 cm x 3 cm to 6 cm x 5 cm). In 7 index fingers wounds on dorsi-fingers, there were 3 cases of 2-wounds, 4 cases of irregular wounds; the area of wounds ranged from 1.0 cm x 0.5 cm to 2.2 cm x 2.0 cm and wounds were treated by the first dorsal metacarpal artery-based distal pedicle dictyo-pattern sublobe flaps (1.2 cm x 0.5 cm to 3.0 cm x 2.2 cm). The donor sites were covered with skin grafts or sutured directly.

RESULTS: All of the flaps survived completely, the wound of recipient site healed at stage I. The free skin graft on donor site survived completely, the wound of donor site healed at stage I. All cases were followed up for 6-12 months (9 months on average). There was good appearance of flaps. The two point discrimination was 5-7 mm for the proximate pedicle flaps and 9-10 mm for the distal pedicle flaps. The thumbs had digital opposition, opposition function, the index fingers had no dysfunction. According to Hand Surgery Association Society of Chinese Medical Association Society standard for the part function evaluation trial-use of upper limb, the results of the total active movement were excellent in 14 cases, and good in 1 case. The line-scar was existed at donor site of the case of direct suture, the function of thumb web had no dysfunction.

CONCLUSION: The first dorsal metacarpal artery-based pedicle dictyo-pattern sublobe flaps can repair the irregular wounds on thumbs and index fingers. It has reliable blood supply and simple operation.