The first dorsal metacarpal artery flaps versus reverse homodigital dorsal flaps for thumb reconstruction: a systematic review and meta-analysis
DOI:
https://doi.org/10.2340/jphs.v59.12435Keywords:
Thumb defects, thumb reconstruction, the first dorsal metacarpal artery flaps, reverse homodigital dorsal flaps, meta-analysisAbstract
Purpose: This review was performed to systematically compare the effectiveness and safety of the first dorsal metacarpal artery flaps (FDMAF) and reverse homodigital dorsal flaps (RHDF) for thumb reconstruction.
Methods: All literatures, which compared FDMAF versus RHDF for thumb reconstruction, were acquired through a comprehensive search in multiple databases from inception until 31st August 2022. A meta-analysis was performed using the Cochrane Collaboration’s RevMan 5.4 software.
Results: A total of 19 articles were retrieved, comprising 396 patients in the FDMAF group and 423 patients in the RHDF group. The pooled estimates suggested that there were no significant differences in venous congestion, complications about flap necrosis and reduced range of motion (ROM) of thumb, static 2-point discrimination (S-2PD) between the two groups. On the other hand, patients in the RHDF group had less vascular crisis (odds ratio [OR] = 3.15, 95%CI, 1.31–7.56), complications about poor cortical reorientation (OR = 440.02, 95%CI, 91.97–2105.27) and higher satisfaction rate (OR = 0.56, 95% CI, 0.33–0.96) than those in the FDMAF group.
Conclusions: The two surgical procedures were both safe and reliable since no significant differences were found in flap necrosis between the two groups. However, the patients in the RHDF group had less complications about vascular crisis, poor cortical reorientation and higher satisfaction rate. Accordingly, we thought RHDF may be more superior for thumb reconstruction than FDMAF.
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References
Ray E, Sherman R, Stevanovic M. Immediate reconstruction of a non replantable thumb amputation by great toe transfer. Plast Reconstr Surg. 2009; 123: 259–67.
https://doi.org/10.1097/PRS.0b013e3181934715 DOI: https://doi.org/10.1097/PRS.0b013e3181934715
Adani R, Tang JB, Elliot D, et al. Soft and tissue repair of the hand and digital reconstruction. J Hand Surg Eur Vol. 2022; 47(1): 89–97.
https://doi.org/10.1177/17531934211051303 DOI: https://doi.org/10.1177/17531934211051303
Appukuttan A, Loh CYY, Puente MM, et al. Reverse superficial palmar branch of radial artery pedicled flap for palmar and digital reconstruction: a systematic review of literature with a retrospective case review. JPRAS Open. 2021; 29: 144–156.
https://doi.org/10.1016/j.jpra.2021.05.008 DOI: https://doi.org/10.1016/j.jpra.2021.05.008
Hurren J, Cormack G. The application of the rotation flap to the dorsum of the hand. Br J Plast Surg. 2000; 53: 491–494.
https://doi.org/10.1054/bjps.2000.3376 DOI: https://doi.org/10.1054/bjps.2000.3376
Urushidate S, Yotsuyanagi T, Yamauchi M, et al. Modified thin abdominal wall flap (glove flap) for the treatment of acute burns to the hands and fingers. J Plast Reconstr Aesthet Surg. 2010; 63(4): 693–699.
https://doi.org/10.1016/j.bjps.2009.01.041 DOI: https://doi.org/10.1016/j.bjps.2009.01.041
Cohen BE, Cronin ED. An innervated cross-finger flap for fingertip reconstruction. Plast Reconstr Surg. 1983; 72(5): 688–697.
https://doi.org/10.1097/00006534-198311000-00020 DOI: https://doi.org/10.1097/00006534-198311000-00020
Megerle K, Palm-Bröking K, Germann G. The cross-finger flap. Oper Orthop Traumatol. 2008; 20(2): 97–102. [In German].
https://doi.org/10.1007/s00064-008-1232-z DOI: https://doi.org/10.1007/s00064-008-1232-z
Littler JW. The neurovascular pedicle method of digital transposition for reconstruction of the thumb. Plast Reconstr Surg. 1953; 12: 303–319.
https://doi.org/10.1097/00006534-195311000-00001 DOI: https://doi.org/10.1097/00006534-195311000-00001
Delikonstantinou IP, Grawanis AI, Dimitriou V, et al. Foucher first dorsal metacarpal artery flap versus littler heterodigital neurovascular flap in resurfacing thumb pulp loss defects. Ann Plast Surg. 2011; 67: 119–122.
https://doi.org/10.1097/SAP.0b013e3181ef6f6d DOI: https://doi.org/10.1097/SAP.0b013e3181ef6f6d
Adani R, Cardon LJ, Castagnetti C. Distal thumb reconstruction using a mini wrap-around flap from the great toe. J Hand Surg. 1999; 24: 437–442.
https://doi.org/10.1054/JHSB.1999.0161 DOI: https://doi.org/10.1054/JHSB.1999.0161
El-Gammal TA, Wei FC. Microvascular reconstruction of the distal digits by partial toe transfer. Clin Plast Surg. 1997; 24: 49–55.
https://doi.org/10.1016/S0094-1298(20)32581-5 DOI: https://doi.org/10.1016/S0094-1298(20)32581-5
Tan H, Luo X, Yang K, et al. Repair of minor tissue defect in hand by transfer of free tissue flap from the toe. Arch Bone Jt Surg. 2014; 2: 11–16.
Hilgenfeldt O. Operativer Daumenersatz und Beseitigung von Greif-störungen bei Fingerverlusten. Stuttgart: Enke, 1950.
Holevich J. A new method of restoring sensibility to the thumb. J Bone Joint Surg. 1963; 45: 496–502.
https://doi.org/10.1302/0301-620X.45B3.496 DOI: https://doi.org/10.1302/0301-620X.45B3.496
Foucher G, Braun JB. A new island flap transfer from the dorsum of the index to the thumb. Plast Reconstr Surg. 1979; 63: 344–349.
https://doi.org/10.1097/00006534-197903000-00008 DOI: https://doi.org/10.1097/00006534-197903000-00008
Kumar V, Satku K, Liu J, et al. The Brunelli reversed flow pedicle flap from the thumb. Plast Reconstr Surg. 1996; 98: 1298–1301.
https://doi.org/10.1097/00006534-199612000-00031 DOI: https://doi.org/10.1097/00006534-199612000-00031
Cavadas P. Reverse osteocutaneous dorsoulnar thumb flap. Plast Reconstr Surg. 2003; 111: 326–329.
https://doi.org/10.1097/00006534-200301000-00056 DOI: https://doi.org/10.1097/00006534-200301000-00056
Hrabowski M, Kloeters O, Germann G, et al. Reverse homodigital dorsoradial flap for thumb soft tissue reconstruction: surgical technique. J Hand Surg Am. 2010; 35(4): 659–662.
https://doi.org/10.1016/j.jhsa.2010.01.013 DOI: https://doi.org/10.1016/j.jhsa.2010.01.013
Moschella F, Cordova A, Pirrello R, et al. Anatomic basis for the dorsal radial flap of the thumb: clinical applications. Surg Radiol Anat. 1996; 18: 179–181.
https://doi.org/10.1007/BF02346124 DOI: https://doi.org/10.1007/BF02346124
Brunelli F, Pegin Z, Cabral J, et al. Dorsal arterial supply to the thumb: new surgical possibilities for palmar skin coverage. Surg Radiol Anat. 1991; 13: 240–242.
https://doi.org/10.1007/BF01627996 DOI: https://doi.org/10.1007/BF01627996
Brunelli F. Le lambeau dorso-cubital du pouce. Ann Chir Main. 1993; 12: 105–114.
https://doi.org/10.1016/S0753-9053(05)80084-5 DOI: https://doi.org/10.1016/S0753-9053(05)80084-5
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71.
https://doi.org/10.1136/bmj.n71 DOI: https://doi.org/10.1136/bmj.n71
Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017; 358: j4008.
https://doi.org/10.1136/bmj.j4008 DOI: https://doi.org/10.1136/bmj.j4008
Furlan AD, Pennick V, Bombardier C, et al. Cochrane Back Review Group2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine (Phila Pa 1976). 2009; 34: 1929–1941.
https://doi.org/10.1097/BRS.0b013e3181b1c99f DOI: https://doi.org/10.1097/BRS.0b013e3181b1c99f
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010; 25: 603–605.
https://doi.org/10.1007/s10654-010-9491-z DOI: https://doi.org/10.1007/s10654-010-9491-z
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539–1558.
https://doi.org/10.1002/sim.1186 DOI: https://doi.org/10.1002/sim.1186
Sun HJ, Lan DZ, Sun TX, et al. Observation on the effect of different flaps in repairing soft tissue defect of thumb tips. Chin J Hand Surg. 2018; 34(1): 53–54. [In Chinese].
TZheng YQ, Xia JJ, Zheng LB, et al. Comparison of the effects of different flaps in repairing thumb pulp defects. Modem J Integr Tradit Chin West Med. 2010; 19(7): 824-824, 862. [In Chinese]. DOI: https://doi.org/10.3736/jcim20100904
Shi HF, Song JB, Cao YH, et al. Comparison between island flap and neurotrophic flap in the repair of thumb pulp defect. Chin Health Care Nutr. 2013; 11: 6235–6235. [In Chinese].
Feng T, Chen JZ, Wang W, et al. Comparison between island flap and neurotrophic flap in the repair of thumb pulp defect. Zhejiang Clin Med J. 2013; 4: 539–540. [In Chinese].
Fu Q, Zhuang YQ, Fu XK, et al. Recovery of soft tissue defect in thumb pulp by five kinds of island skin flap with cutaneous nerve. J Xinxiang Med Univers. 2008; 25(3): 253–255. [In Chinese]
Cai GR, Li QY, Liu Q, et al. Comparison of two kinds of pedicled skin flaps in repairing thumb skin defects [J]. Chin J Microsurg. 2014; 37(3): 269–271. [In Chinese]
Liu ZX, Liu S, Liu H, et al. Therapeutic effect analysis of distal phalangeal skin defect of thumb with two kinds of island flaps. Orthoped J Chin. 2009; 17(22): 1757–1759. [In Chinese]
Gao P, Pan CH, Zhao YX, et al. Repair of distal thumb defect refers to two types of skin flap. Acta Acad Med Weifang. 2014; 1: 25–27. [In Chinese]
Liu AM, Zou YG, Luo XC, et al. The thumd skin lacks like five kind of repair method comparison. Yiyao Qianyan. 2018; 8(3): 38–39. [In Chinese]
Li JM, Zheng SC, Li DX, et al. Repair of soft tissue defect of the thumb by flaps. J Chongqing Med Univers. 2010; 35(11): 1719–1721. [In Chinese]
Feng ML, He Y, Dong T, et al. Analysis of treatment methods for microscopic repair of soft tissue defects of the thumb. Chin J Microsurg. 2010; 33(6): 517–518. [In Chinese]
Dong HS, Gao SH, Jiao C, et al. Various island flaps for repairing subtotal soft tissue defect of the thumb. J Chin Phys. 2013; 15 (12): 1628-1631. [In Chinese]
Wang XX, Zhang WW, Fang XL, et al. Comparative clinical efficacy of flap repair of thumb pulp defects [J]. Modern Pract Med. 2007; 19(10): 814–815. [In Chinese]
Yu BZ. The comparative study and clinical analysis of different methods of the repair of thumb pulp tissues. Hebei Medical University; 2011. [In Chinese]
Feng B, Wu YC, Zhang XY, et al. Treatment of skin and soft tissue defect in the hand with various flaps. Chin J Inj Repair Wound Heal (Electronic Edition). 2012; 7(4): 360–366. [In Chinese]
Wu XP, Liu WH, Zhao GL, et al. Comparison research of surgery of index finger dorsal Island flap and thumb dorsal Island flap in the repair of skin defect of thumb. Jilin Med J. 2016; 37(3): 569–571. [In Chinese]
Li WQ, Wang L, Gong YX, et al. Coverage of the thumb soft tissue defect by five kinds of flaps. Chin J Orthopaed. 2004; 24(8): 474–477. [In Chinese]
Wang W, Yu DL, Wen YY, et al. Efficacy comparison of two types of flaps in the repair of thumb pulp defects. Chin J Aesth Plastic Surg. 2020; 31(7): 405–408. [In Chinese]
Tang HB, Liu JF, Yi SK, et al. Comparison of the therapeutic effects of the dorsal index finger and radial thumb neurocutaneous flap in repairing the distal defect of the thumb. Chin J Hand Surg. 2010; 26(6): 382–383. [In Chinese].
Sherif MM. First dorsal metacarpal artery flap in hand reconstruction. J Hand Surg A. 1994; 19: 26–31.
https://doi.org/10.1016/0363-5023(94)90220-8 DOI: https://doi.org/10.1016/0363-5023(94)90220-8
Pistre V, Pellisier P, Martin D, et al. Vascular blood supply of the dorsal side of the thumb, first web and index finger: anatomical study. J Hand Surg B 2001; 26: 98–104.
https://doi.org/10.1054/jhsb.2000.0538 DOI: https://doi.org/10.1054/jhsb.2000.0538
Braun JB, Werner JE, Borrelly J, et al. Quelques notions d’anatomie arterielle de la main et leurs applications chirurgicales. Ann Chir 1979; 33: 701–706.
Muyldermans T, Hierner R. First dorsal metacarpal artery flap for thumb reconstruction: a retrospective clinical study. Strategies Trauma Limb Reconstr. 2009; 4(1): 27–33.
https://doi.org/10.1007/s11751-009-0056-1 DOI: https://doi.org/10.1007/s11751-009-0056-1
Chang SC, Chen SL, Chen TM, et al. Sensate first dorsal metacarpal artery flap for resurfacing extensive pulp defects of the thumb. Ann Plast Surg. 2004; 53: 449–454.
https://doi.org/10.1097/01.sap.0000137134.15728.dd DOI: https://doi.org/10.1097/01.sap.0000137134.15728.dd
Eski M, Nisanci M, Sengezer M, et al. Correction of thumb deformities after burn: versatility of first dorsal metacarpal artery flap. Burn. 2007; 33(1): 65–71.
https://doi.org/10.1016/j.burns.2006.04.030 DOI: https://doi.org/10.1016/j.burns.2006.04.030
El Khatib HA. Clinical experiences with the extended first dorsal metacarpal artery island flap for thumb reconstruction. J Hand Surg [Am].1998; 23(4): 647–652.
https://doi.org/10.1016/S0363-5023(98)80050-6 DOI: https://doi.org/10.1016/S0363-5023(98)80050-6
Zancolli EA, Angrigiani C. Posterior interosseous island forearm flap. J Hand Surg Br. 1988; 13: 130–135.
https://doi.org/10.1016/0266-7681_88_90121-0 DOI: https://doi.org/10.1016/0266-7681_88_90121-0
Bao QY, Xiao CW, Peng F, et al. Restoration of thumb sensibility with innervated reverse homodigital dorsoradial flap. J Reconstr Microsurg. 2014; 30(1): 15–20.
https://doi.org/10.1055/s-0033-1345430 DOI: https://doi.org/10.1055/s-0033-1345430
Daniali L, Azari K. Reconstruction of a distal dorsal thumb defect. Eplasty. 2013; 13: ic42.
Terán P, Carnero S, Miranda R, et al. Refinements in dorsoulnar flap of the thumb: 15 cases. J Hand Surg Am. 2010; 35(8): 1356–9.
https://doi.org/10.1016/j.jhsa.2010.05.016 DOI: https://doi.org/10.1016/j.jhsa.2010.05.016
Moschella F, Cordova A. Reverse homodigital dorsal radial flap of the thumb. Plast Reconstr Surg. 2006; 117(3): 920–6.
https://doi.org/10.1097/01.prs.0000200665.73624.6d DOI: https://doi.org/10.1097/01.prs.0000200665.73624.6d
Aggag AM, Aboel-Hasan WS, Abdel-Aal M, et al. A comparison of outcomes of reconstruction of palmar versus dorsal defects of the thumb using a first dorsal metacarpal artery flap with a cutaneous bridge segment. J Hand Surg Asian Pac Vol. 2022; 27(2): 313–319.
https://doi.org/10.1142/S2424835522500278 DOI: https://doi.org/10.1142/S2424835522500278
Ghoraba SM, Mahmoud WH. Outcome of thumb reconstruction using the first dorsal metacarpal artery Island flap. World J Plast Surg. 2018; 7(2): 151–158.
Zhang X, Shao X, Ren C, et al. Reconstruction of thumb pulp defects using a modified kite flap. J Hand Surg Am. 2011; 36: 1597–603. DOI: https://doi.org/10.1016/j.jhsa.2011.06.033
Wang H, Chen C, Li J, et al. Modified first dorsal metacarpal artery island flap for sensory reconstruction of thumb pulp defects. J Hand Surg Eur. 2016; 41: 177–184.
https://doi.org/10.1177/1753193415610529 DOI: https://doi.org/10.1177/1753193415610529
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