FDMA FLAP FOR THUMB

RECONSTRUCTION
• pure island flap carrying the FDMA, subcutaneous veins, and branches of the
radial sensory nerve in a single stage
• The FDMA island flap can reach the volar and dorsal aspects of the distal thumb
and is considered a versatile workhorse flap for innervated distal thumb soft
tissue coverage.
• proximal limit of the flap is the MP joint, and the distal limit is the proximal IP
joint
• Under tourniquet hemostasis, the flap is elevated in the loose areolar plane
above the extensor tendon paratenon. Dissection generally moves from distal to
proximal and from the ulnar to the radial side. Extreme care must be taken at
the radial border of the MP joint because this is where the FDMA enters the
flap’s subcutaneous network.
•The pedicle is dissected by incising the interosseous fascia at the radial
edge of the muscle and second metacarpal periosteum at the ulnar
edge. The deep periosteal incision is carried radially and deep to the
muscle fascia. The dorsal veins and sensory branches of the radial
nerve that typically enter the flap over the ulnar border of the MP joint
are included in the pedicle. The pedicle is dissected back to the pivot
point at the juncture of the first and second metacarpals
Teardrop shape incision