Extended distally based DMCA flap in combination w

Authors: Till Wagner Nicholas Slater Dietmar Ulrich

Publish Date: 2015/11/14

Volume: 39, Issue: 1, Pages: 69-72

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Abstract

A 23yearold male student presented to our clinic with a traumatic complex ring avulsion of his right dominant index finger Clinical evaluation revealed a complete distal amputation of the DIP joint with a laceration of the soft tissue at the middle phalanx and a rupture of the FDP2tendon far proximally We hereby present the patient’s clinical outcome after reconstruction with a distally based extended DMCAII flap To our own knowledge this is the first report of an extended distally based DMCA flap for coverage of a class IVd ring avulsion injury in combination with autologous amputate skin transplantationSince the first description of the DMCA flap in 1990 1 and his modification the flap quickly became part of the plastic surgeon’s armamentarium for the coverage of soft tissue defects of the hand 2 Despite its easy use the flap has not gained its position in amputation and deglovement injuries Today with the ongoing discussion regarding indications for replantation after ring avulsions 3 there is still a lack of surgical options due to absent amputates or amputates in a poor condition Even in recent studies 4 which have shown more satisfying results in replantation after complete ring avulsion these issues are not addressed Most authors agree that amputations distal of the FDS insertion with intact PIP joint are potential candidates for replantation 5 When the injured amputate is not available or replantable ray resection is estimated to be the best option except in patients with manual jobs where preserving the MCP joint is said to be favorable 6 In the current case we show that a wellknown locoregional flap such as the DMCA flap may well serve as a solution where the amputate was not suitable for replantation and the patient negotiates further amputation The advantage of this procedure is the relatively short operating time with less need for extensive vascular debridement and a short recovery time to normal life To our knowledge this is the first description of a case report of a DMCA flap in combination with an autograft from the amputate for a softtissue coverage The patient achieved a good functional and cosmetic outcome and was satisfied with the daily usability of the fingerOpen Access This article is distributed under the terms of the Creative Commons Attribution 40 International License http//creativecommonsorg/licenses/by/40/ which permits unrestricted use distribution and reproduction in any medium provided you give appropriate credit to the original authors and the source provide a link to the Creative Commons license and indicate if changes were made

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