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ISSN 1405-0625 (Print)

2024, Number 4

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Cir Plast 2024; 34 (4)

Integration of the concepts of the first dorsal metacarpal flap and Holevich and Foucher techniques in the skin coverage of the thumb

Rendón-Medina MA, Rendón-Pimentel MA, Covarrubias-Noriega A, Hanson-Viana E, Montes-Munguía M, Manzali-Flores A, Ramírez-Cahuana SA

Language: Spanish
References: 17
Page: 163-168
PDF size: 368.31 Kb.


ABSTRACT

Local flaps in reconstructive hand surgery are vital for defect repair and functional restoration. The first dorsal metacarpal flap, described by Hilgenfeldt, has come forth as a reliable option, due to its anatomical design ensuring good vascularization. Subsequent advancements by Holevich emphasized skin inclusion for sensory preservation, while Foucher and Braun made further modifications focusing on preserving dorsal skin and neural elements. This study aims at describing a novel technique, integrating concepts from the first dorsal metacarpal flap and Holevich and Foucher techniques for efficient and effective thumb reconstruction. Our technique combines Doppler-guided flap planning with meticulous incision design and perivascular fat preservation. Cadaver studies were carried out to evaluate pedicle flow measured by oximetry, supporting the reliability of our approach. Clinical application of the technique yielded favorable outcomes, with improved sensory perception and flap viability. Oximetry measurements demonstrated enhanced pedicle flow compared to traditional techniques. We conclude that integrating the first dorsal metacarpal flap and Holevich and Foucher techniques offers a reproducible approach for thumb reconstruction, balancing vascular integrity and functional outcomes. Individualized incision placement is recommended to minimize scar-related complications and optimize thumb mobility.


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