Foucher's first dorsal metacarpal artery flap for thumb reconstruction: Evaluation of 21 cases

Background: Coverage of part of a soft tissue defect in the thumb, without bone shortening and without long-lasting immobilization in an inappropriate position leading to stiffness, is difficult to achieve. Objectives: To report our experience using Foucher's modification of the first dorsal metacarpal artery flap for thumb reconstruction in 21 cases. Methods: Foucher's flap is based on the neurovascular structures of the first dorsal metacarpal artery flap and radial nerve-sensitive branches on the dorsum of the second metacarpal and proximal phalanx. The cause of injury was work-related in all 21 cases. The patients' mean age was 37 (range 17-68 years), and mean follow-up was 19 months (range 12-31). Emergency surgery was performed in 13 patients with a time delay after injury of 4-12 hours. The minimum defect was 12×18 mm and the maximum 20×40 mm. Pedicular length was 55-95 mm. A skin bridge was left intact in 16 cases. In two cases of early postoperative venous congestion and flap loss, a cross-finger flap was performed as a salvage procedure. Results: Subjective satisfaction score was 8.37/10 (range 4-10); cold intolerance was experienced in 60% and dysesthesia in 33%. All except one patient are able to use their thumb in daily activity. Loss of mobility in the proximal interphalangeal joint of the index finger was less than 20 degrees. Semmes-Weinstein sensitivity evaluation score was 3.61-4.31 on the flap and 0-6.65 on the donor site. Two-point discrimination was 10.8 mm (range 8-20). Grip strength was reduced by 15% compared to the unaffected hand (hand dominance was not taken into consideration). Rehabilitation was not consistent as almost all the patients were living in another location. Conclusions: First DMCA pedicle flap is a successful thumb reconstruction method, especially in patients not disturbed by its cosmetic appearance