Dorsal metacarpal reverse flaps: anatomical basis and clinical application

The presence of distal intermetacarpal anastomoses between dorsal and pahnar vascular networks makes it possible to raise distally-based cutaneous island flaps oriented along the axis of the dorsal metacarpal arteries. These flaps receive a reverse-flow vascularisation. Distal intermetacarpal anastomoses were found consistently in 35 hands from adult cadavers. The exact location of these anastomoses varied with the course of the dorsal metacarpal artery. Thus, island flaps can be raised consistently from the dorsal aspect of the hand and rotated around a distal inter-metacarpal pivot. These flaps are suitable for covering the dorsal aspect of the proximal phalanx and the proximal interphalangeal joint. Journal of Hand Surgery (British Volume, 1991) 16B: 400-405 In a previous study on the anatomy of the vascular network of the first intermetacarpal space (Dautel and Merle, 1989), we noted the highly variable pattern of anastomoses between palmar and dorsal vascular net-works. The question arose as to whether these anasto-moses, in spite of their variability, could provide reverse