gms | German Medical Science

Objectives/Interrogation: After dorsal capsulotomy or capsulectomy for the extension contracture of the metacarpophalangeal joint (MCPJ), the divided capsules were left for secondary healing. Despite vigorous rehabilitation postoperatively, reemergent fibrotic capsule restricting the motion was inevitable. In this study, the reversed dorsal metacarpal adipofascial flap was used to resurface the MCPJ capsule in the cases with posttraumatic contracture.

Methods: Dorsal approach with a curvilinear Incision was performed. Tenolysis of the extensor tendon was undergone from zone 4 to zone 6. The proximal sagittal slings could be divided to expose the MCPJ. Capsulotomy and division of dorsal collateral ligaments was continued to ensure least resistance with passive flexion of the joint.

The reversed dorsal metacarpal adipofascial (RDMA) flap was dissected superficial to the extensor tendon. The longitudinal axis of the flap locates in the center between two metacarpi, and the pivot point is the midpoint between the two metacarpal necks. The flap was turned and inset to the joint capsule with passive flexion of the MCPJ.

Results and Conclusions: The technique was performed in 4 cases, including one 3rd MCPJ and three 5th MCPJs. All contracture were resulted from previous metacarpal fracture. Pre-operative active motion of the involved MCPJ was from 0 to 35 degrees. The patients were followed for 6 to 17 months. The final active motion was from 55 to 82 degrees. The improvement of active motion was from 40 to 70 degrees.

The RDMA flap resurfacing the divided MCPJ capsule provides primary healing of the defect and a better gliding surface for the extensor tendon on the dorsal MCPJ. All the patients got improvement without relapse of extension contracture.