Direct and Reversed Dorsal Digito-metacarpal Flaps: A Review of 24 Cases

At final follow-up, we measure the sensibility of the flaps using the static 2-point discrimination test. The Static 2-point discrimination test determines the minimal distance at which a subject can sense the presence of two needle. The modified American Society for Surgery of the Hand guidalines are used to stratify discriminator measurements(excellent <6 mm, good 6-10 mm, fair 11-15 mm, poor >15 mm). Each area is tested 3 times with a Discriminator (Ali Med, Dedham, MA). Two out of 3 correct answers are considered proof of perception before proceeding to another lower value. We stopp at 4mm as a limit of 2PD and consider this normal. The measurements are performed at a single time point at final follow up.

Inclusion criteria

• the injured and adjacent fingers are unable to be used as the donor due to multiple digital injuries
• a soft tissue defect > 1.5 cm in length with exposed bone or tendon
• the reverse DMA flap may not be appropriate for tissue reconstruction due to the concomitant injuries or due to the limitation of the rotation arc
• a patient between 15 and 60 years of age

Exclusion criteria

• concomitant injuries involved all the finger that precluded their use as donor sites
• a defect less than 1.5 cm in length
• injuries to the course of the vascular pedicle