Objective: To summarize the clinical experiences of various types of the second dorsal metacarpal artery (SDMA) flap for hand reconstruction.
Methods: From 1988 to 2003, 139 SDMA flaps were transferred for hand injuries. The flaps were used in 5 types according to vascularization and technique in transplantation:orthograde pedicled island SDMA flaps in 37 cases (cutaneous in 24 and teno-cutaneous in 13), retrograde pedicled island SDMA flaps in 25 cases (cutaneous in 19 and teno-cutaneous in 6), double pivot SDMA flaps in 36 cases (cutaneous in 28 and tenocutaneous in 8), distal perforator branch pedicled flaps in 19 cases (cutaneous in 16 and composite in 3), free SDMA flaps in 22 cases (cutaneous in 15 and composite in 7). The skin islands were 3.0 cm x 1.5 cm to 6.3 cm x 5.0 cm in size.
Results: Of the 139 flaps, 135 flaps survived completely, 3 survived partially, and 1 failed in the operation because of intractable vascular spasm. Follow-up was done in 116 cases for 12 to 57 months. The flap had good texture and color match. The two-point discrimination was 5 to 9 mm in 78 sensate flaps, while it was 10 to 15 mm in 38 nonsensate flaps. In 21 tenocutaneous flaps, the TAM score of range of motion was 60% to 70% of the healthy side.
Conclusion: The SDMA flap has a constant and reliable vessel and a thin, pliable, and good-quality skin. It is versatile in creating composite flaps. It is a good flap resource for hand and finger reconstruction.