BACKGROUND– Traumatic thumb injury results in a much more significant impact on daily activities than do injuries to the other digits. Daily tasks involving pinch, grip, grasp and precision handling are more easily accomplished with an opposable thumb. Restoration of sensibility after traumatic loss of the palmar and dorsal aspects of the thumb is of utmost importance for the usefulness of the hand. The First Dorsal Metacarpal Artery (FDMA) flap is an island pedicled flap proximally based on the first dorsal metacarpal artery and veins. A branch of radial sensory nerve is incorporated in the flap to make it sensate. In this study we have evaluated the effectiveness of FDMA flap in reconstruction of various defects of the thumb and first web space.

METHODS– This is a prospective study including 20 patients presenting with defects on the dorsal and volar aspects of thumb and first web space in a tertiary care hospital in eastern India. All defects were reconstructed with a sensate FDMA flap in a single stage over a period of 2 years.

RESULTS–The FDMA flap provided a thin, pliable and stable coverage of all the  soft tissue defects around the thumb and  first web space. No case of complete flap failure was noted. The sensory function was evaluated with static two point discrimination (mean value 12.77 mm). The mobility of the first ray was evaluated with Kapandji score which was found to be 7.95 over 10, reflecting a good opposition of the reconstructed thumb. The grip strength was also adequate in all patients. The subjective satisfaction score was 7.25 over 10.

CONCLUSION– The FDMA flap is a reliable heterodigital neurovascular island pedicled flap for reconstruction of soft tissue defects around the thumb and first web space, offering acceptable functional and aesthetic outcomes with minimal donor site morbidity. It provides pliable, durable and sensate coverage in a single stage procedure.