Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Use of Heparin Cream for Venous Congestion in the Extended Reverse Metacarpal Artery Flap: A Case Report

  • Tatar, Burak Erguun (Department of Plastic Surgery, University of Health Sciences, Bagcilar Training and Research Hospital) ;
  • Sabanciogullarindan, Fahri (Department of Plastic Surgery, University of Health Sciences, Bagcilar Training and Research Hospital) ;
  • Gelbal, Caner (Department of Plastic Surgery, University of Health Sciences, Bagcilar Training and Research Hospital) ;
  • Bozkurt, Mehmet (Department of Plastic Surgery, University of Health Sciences, Bagcilar Training and Research Hospital)
  • Received : 2022.01.14
  • Accepted : 2022.04.12
  • Published : 2022.09.15
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Abstract

Finger dorsum defects are a challenging situation. Many reconstruction methods are used in these defects. Extended reverse dorsal metacarpal artery (RDMA) flap is used in dorsal finger reconstruction. Venous congestion in this flap is most important cause of flap failure. In this case, we presented a case in which we used heparin cream due to development of venous congestion in our patient who underwent an extended RDMA flap. A 24-year-old female patient presented to the emergency department with a defect of dorsal of left-hand fourth finger. Defect was covered with an extended RDMA flap. On postoperative first day, venous congestion was observed, and heparin cream was applied three times a day on flap. The signs of venous congestion were regressed. Tissue healed as a result of superficial epidermolysis and skin grafting. No functional limitation was observed in sixth-month postoperative control. Venous congestion is the most important cause of flap failure of extended RDMA flaps. Generally, subcutaneous heparin administration and leech therapy are used. In our case, heparin was applied as a cream instead of subcutaneously, and flap healing was observed as a result of superficial epidermolysis. Heparin cream application can also be used as a treatment option in flaps with venous congestion.

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References

  1. Balan JR, Mathew S, Kumar P, et al. The reverse dorsal metacarpal artery flap in finger reconstruction: a reliable choice. Indian J Plast Surg 2018;51:054-9 https://doi.org/10.4103/ijps.IJPS_37_17
  2. Quaba AA, Davison PM. The distally-based dorsal hand flap. Br J
  3. Maruyama Y. The reverse dorsal metacarpal flap. Br J Plast Surg 1990;43(01):24-27 https://doi.org/10.1016/0007-1226(90)90041-W
  4. Shen H, Shen Z, Wang Y, Zhang K, Zhang Z, Dai X. Extended reverse dorsal metacarpal artery flap for coverage of finger defects distal to the proximal interphalangeal joint. Ann Plast Surg 2014;72 (05):529-536 https://doi.org/10.1097/SAP.0b013e318269e510
  5. Balan JR. Free toe pulp flap for finger pulp and volar defect reconstruction. Indian J Plast Surg 2016;49(02):178-184 https://doi.org/10.4103/0970-0358.191319
  6. Jiao H, Ding X, Liu Y, Zhang H, Cao X. Clinical experience of multiple flaps for the reconstruction of dorsal digital defects. Int J Clin Exp Med 2015;8(10):18058-18065
  7. Rehim SA, Kowalski E, Chung KC. Enhancing aesthetic outcomes of soft-tissue coverage of the hand. Plast Reconstr Surg 2015;135 (02):413e-428e https://doi.org/10.1097/PRS.0000000000001069
  8. Eberlin KR, Chang J, Curtin CM, Sammer DM, Saint-Cyr M, Taghinia AH. Soft-tissue coverage of the hand: a case-based approach. Plast Reconstr Surg 2014;133(01):91-101
  9. Chen S-L, Chou T-D, Chen S-G, Cheng TY, Chen TM, Wang HJ. The boomerang flap in managing injuries of the dorsum of the distal phalanx. Plast Reconstr Surg 2000;106(04):834-839 https://doi.org/10.1097/00006534-200009020-00013
  10. Chen C, Tang P, Zhang X. The dorsal homodigital island flap based on the dorsal branch of the digital artery: a review of 166 cases. Plast Reconstr Surg 2014;133(04):519e-529e https://doi.org/10.1097/PRS.0000000000000016
  11. Karakol P, Sezgic M, Tatar BE, Gelbal C, Uslu C. The use of dorsoradial forearm flap for the treatment of dorsal hand defect. J Surg Case Rep 2020;2020(07):rjaa153 https://doi.org/10.1093/jscr/rjaa153
  12. Al-Qattan MM. The cross-digital dorsal adipofascial flap. Ann Plast Surg 2008;60(02):150-153 https://doi.org/10.1097/SAP.0b013e31805a65ac
  13. Yan H, Fan C, Zhang F, Gao W, Li Z, Zhang X. Reconstruction of large dorsal digital defects with arterialized venous flaps: our experience and comprehensive review of literature. Ann Plast Surg 2013;70(06):666-671 https://doi.org/10.1097/SAP.0b013e3182433575
  14. Beldame J, Havet E, Auquit-Auckbur I, Lefebvre B, Mure JP, Duparc F. Arterial anatomical basis of the dorsal digito-metacarpal flap for long fingers. Surg Radiol Anat 2008;30(05):429-435 https://doi.org/10.1007/s00276-008-0347-0
  15. Sebastin SJ, Mendoza RT, Chong AKS, et al. Application of the dorsal metacarpal artery perforator flap for resurfacing softtissue defects proximal to the fingertip. Plast Reconstr Surg 2011;128(03):166e-178e https://doi.org/10.1097/PRS.0b013e318221ddfa
  16. Koch H, Bruckmann L, Hubmer M, Scharnagl E. Extended reverse dorsal metacarpal arteryflap: clinical experience and donor site morbidity. J Plast Reconstr Aesthet Surg 2007;60(04):349-355 https://doi.org/10.1016/j.bjps.2006.03.066
  17. Karacalar A, Ozcan M. A new approach to the reverse dorsal metacarpal artery flap. J Hand Surg Am 1997;22(02): 307-310 https://doi.org/10.1016/S0363-5023(97)80168-2
  18. Vuppalapati G, Oberlin C, Balakrishnan G. "Distally based dorsal hand flaps": clinical experience, cadaveric studies and an update. Br J Plast Surg 2004;57(07):653-667 https://doi.org/10.1016/j.bjps.2004.05.009
  19. He Y-F, Wang Y-R, Li L-F, Wang SH, Ye JW. [Effect of low molecular heparin sodium cream on the content of serum nitric oxide in random pattern skin flap: experiment with rats]. Zhonghua Yi Xue Za Zhi 2007;87(43):3092-3094
  20. Liu B, Li L, He Y, et al. The influence of zi-hua burn cream on the survival of random skin flaps in rats. Zhonghua zheng xing wai ke za zhi = Zhonghua zhengxing waike zazhi = . Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 2013;29:370-375