Summary
Distally based DMCA flaps are well established in reconstructive hand surgery. They
comprise the dorsal flap described by Quaba and the DMCA flaps described by Earley,
Milner and others. The most frequent indications for these flaps are soft tissue defects
of the dorsum of the proximal phalanx and the total length of the finger. Since its
introduction several modifications have been developed to match specific defect requirements;
these include: the development of pure fascial DMCA flaps, the use of DMCA flaps in
dorsally grafted burned hands and modifications in design to avoid ‘tunnelling’ and
to permit skin-skin defect closure. The purpose of this article is to provide an overview
of the evolution and refinements of the DMCA flaps based on the experience of a single
centre.
The DMCA flaps provide one stage coverage of excellent quality with independent vascularisation
and permit primary closure of the recipient site without sacrificing relevant arteries
(e.g. proper digital artery). However, the DMCA flaps also possess drawbacks, for
example, apart from the fact that this technique is quite demanding, possible hair
growth and a visible scar on the exposed dorsal part of the hand present aesthetic
problems for some patients.
Despite these limitations, DMCA flaps are considered to be extremely useful.
Keywords
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Article info
Publication history
Published online: May 21, 2007
Accepted:
March 7,
2007
Received:
November 1,
2006
Identification
Copyright
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
