Artikel
Subjective and Objective Assessment of First Dorsal Metacarpal Artery Flaps Used in Traumatic Defects of Thumb and Dorsum of the Hand
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Autoren
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Kadir Uzel
- University of Mersin, School of Medicine, Department of Orthopaedics and Traumatology, Division of Hand Surgery, Mersin, Turkey
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Velat Çelik
- University of Mersin, School of Medicine, Department of Orthopaedics and Traumatology, Division of Hand Surgery, Mersin, Turkey
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Yusuf Hakan Abaci
- University of Mersin, School of Medicine, Department of Orthopaedics and Traumatology, Mersin, Turkey
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Metin Manouchehr Eskandari
- University of Mersin, School of Medicine, Department of Orthopaedics and Traumatology, Division of Hand Surgery, Mersin, Turkey
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: First dorsal metacarpal artery flaps (1.DMF) are used for reconstruction of thumb distal amputation stumps or other fingers' dorsal defects. The aim of this study was assessment of the results of these flaps with special emphasis on the objective sensorial status in comparison with contralateral healthy regions
Methods: The study was done in 7 patients whose traumatic defects were repaired by 1.DMAF between September 2015 and March 2018. Four of them had unrepairable thumb distal phalangeal amputations. Amputation was distal to IP joint level in one patient, at IP in 2 and at MCP in another one. Two of the dorsal defects were over the 3rd finger and one over the dorsum of the hand. Mechanism of injury was crush in all of them. All of patients were men with a mean age of 43 (min:24-max:66) years. Operations were performed under local anaesthesia in 4 and general anaesthesia in 3. Mean dimensions of the flaps were 2X1.5 cm and included the dorsal cutaneous branch of radial nerve. A tunnel was developed under the skin to advance the flaps toward the defects in thumb amputations. Donor site was closed by skin graft. Assessment of study parameters was done at a mean time of 20,14(6-36) months postoperatively.
Results and Conclusions: There was no flap necrosis in any of the patients. Four patients rated their sensorial status as good, 2 as moderate and 1 as weak. Five of the patients stated no cold intolerance, 1 stated minimal and 1 moderate intolerances. Four patients rated their overall satisfaction as good and 3 as moderate. There was flexion contracture in thumb MCP joints in 2 patients. There was thumb nail deformity in 1 patient.
Static two point discrimination (2PD) test showed no significant difference (p=0,084) between the flap sites (mean=7.00 mm, SD=3,56) and similar healthy contralateral hand regions (mean=4,29, SD=1,38). Semmes Weinstein monofilament (SWM) test showed a significant difference (p=0,007) between the flap sites (mean=3,43, SD=0,79) and similar healthy contralateral hand regions (mean=2,29, SD=0,49).
Regarding the patients' point of view, subjective results of 1.DMAF's remain between overall ranges of moderate to good. But regarding the results of SWMF, as a reliable objective test in assessment of protective sensation loss, although innervated this flap type has no good sensorial results. We think that static 2PD remains as an unreliable tactile perception test.
