Extended Reverse Dorsal Metacarpal Artery Flap: A Case Report.

We present the case of a 77-year-old male agricultural worker with poorly controlled type 2 diabetes mellitus (HbA1c 9.2%) who experienced a dorsal middle phalanx injury. He was otherwise healthy, with no history of hypertension, peripheral vascular disease, or coronary artery disease. The patient was a non-smoker and was not on anticoagulants, antiplatelet agents, or immunosuppressive drugs at the time of injury. He sustained a dorsal middle phalanx injury with extensor tendon exposure caused by a rotary grinder. An extended reverse-flow dorsal metacarpal artery (DMA) flap based on the second metacarpal vessel was performed immediately upon arrival at the emergency department. The patient showed favorable evolution, with minor flap loss and no need for further intervention. This report highlights the utility of this technique for achieving functional and aesthetic reconstruction in high-risk individuals.