[The first dorsal metacarpal artery neurovascular osteocutaneous flap--a new method of distal thumb reconstruction].

Basing on the earlier experience with neurovascular flap from the dorsal part of the index when reconstructing soft tissues of thumb and thenar, first of the authors elaborated a method of harvesting this flap together with a dorsal aponeurosis and bone fragment of the proximal phalanx. Blood flow comes from the periosteum of the proximal phalanx. Many small vessels penetrate into it from the dorsal soft tissues thus piercing central part of the dorsal aponeurosis in many points. The flap was used in 25 year old male who had secondary reconstruction of the mutilating thumb pulp when the nail and nail matrix were preserved and in 27 year old male after amputation and replantation of nearly completely damaged distal part of the thumb. In this case bone healing was not obtained in spite of the arthrodesis and extensive impairment of digital nerves did not allow to carry out a primary nerve suture. A bone fragment in the flap was used to perform secondary arthrodesis and well innervated soft tissues of the flap improved sensation of the thumb distal part. The functional and cosmetic results were good. During thirteen and eleven years follow up the patients did not show any complications both in the donor and recipient sites.