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First Web Space Reconstruction Using a Dorsal Metacarpal Artery Perforator Flap: A Further Application of the Quaba Flap

Perera, Nisal K. M.B.B.S.; Rozen, Warren M. M.B.B.S., Ph.D.; Niumsawatt, Vachara M.B.B.S.; Ek, Edmund F.R.A.C.S.

Plastic and Reconstructive Surgery: January 2014 - Volume 133 - Issue 1 - p 74e–76e
doi: 10.1097/01.prs.0000436804.58165.9a
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Department of Plastic and Reconstructive Surgery, The Northern Hospital, Epping, Victoria, Australia

Correspondence to Dr. Perera, Department of Plastic and Reconstructive Surgery, The Northern Hospital, 185 Cooper Street, Epping, Victoria 3076, Australia, kalhara_01@hotmail.com

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Sir:

Soft-tissue defects involving the hands are frequently encountered in reconstructive surgery. In 1990, Quaba and Davidson described a series of reverse dorsal hand flaps that were particularly useful in resurfacing web spaces.1 Since their early conception, numerous uses for these flaps have been identified.2 Although the use of a distally based dorsal metacarpal artery perforator flap (Quaba) to close a first web space defect of the hand was mentioned in the original article, to our knowledge, no subsequent cases to illustrate this have been reported in the literature. We hereby report our recent experience.

A 35-year-old male butcher presented with an abscess involving the first web space of his left hand. After undergoing two operative procedures to wash out and debride the lesion, the patient was left with a 3 × 2-cm skin deficit exposing neurovascular structures to the index finger (Fig. 1). To obviate the possible complications of contracture and extensive scar formation in the first web space by allowing this defect to close by secondary intention, it was decided to use a Quaba flap to close the defect.

Fig. 1

Fig. 1

Following washout and debridement of the existing wound, a Quaba flap extending from the metacarpophalangeal level to the dorsal wrist crease, approximately 2 cm wide, was raised as an island flap of the second interosseous space perforator. The flap was then rotated 90 degrees to fill the existing tissue defect. After flap insetting, the donor site was closed primarily (Fig. 2). At last review, there were no complications related to flap survival.

Fig. 2

Fig. 2

Various methods of first web space reconstruction have been described.3 These include, but are not limited to, skin grafting; methods using local flaps, including Z plasty, V-Y plasty, and their variants; four-flap and five-flap techniques; first dorsal metacarpal artery flaps; and microsurgical anterolateral thigh flaps.

For small defects, small local flaps such as Z plasties are useful. For larger defects, importation of skin into the defect is required. For these cases, locoregional flaps are favored, and most are random-pattern flaps (i.e., Strauch, Brand, and manta ray flaps). Axial pattern flaps such as the Quaba flap, however, are preferred where feasible due to a more robust blood supply.

Dorsal metacarpal artery flaps have proven to be useful tools in hand defect reconstruction. They provide a reconstructive option where the anatomy is both predictable and reliable. Furthermore, this reconstruction has the benefit of being a local flap with negligible donor-site morbidity. In this case, a Quaba flap was used to avoid the arduous process of allowing a significant skin defect in a cosmetically and functionally sensitive area to heal by secondary intention. A delayed operation to alleviate significant contracture formation was also avoided.

The kite flap as described by Foucher is another dorsal metacarpal artery–based option that can be used to reconstruct the first web space.4 When compared with the Quaba flap, its only limitation is that it frequently requires skin grafting to the donor site.

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DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.

Nisal K. Perera, M.B.B.S.

Warren M. Rozen, M.B.B.S., Ph.D.

Vachara Niumsawatt, M.B.B.S.

Edmund Ek, F.R.A.C.S.

Department of Plastic and Reconstructive Surgery

The Northern Hospital

Epping, Victoria, Australia

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REFERENCES

1. Quaba AA, Davison PM. The distally-based dorsal hand flap. Br J Plast Surg. 1990;43:28–39
2. Gregory H, Heitmann C, Germann G. The evolution and refinements of the distally based dorsal metacarpal artery (DMCA) flaps. J Plast Reconstr Aesthet Surg. 2007;60:731–739
3. Grishkevich VM. First web space post-burn contracture types: Contracture elimination methods. Burns. 2011;37:338–347
4. Foucher G, Braun JB, Merle M, Sibilly A. [The “skin kite flap” (author’s transl)]. Ann Chirurg. 1978;32:593–596
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