Stepladder dorsal metacarpal flaps for dorsal finger and hand reconstruction

Evolving paradigm in treatment of Merkel cell carcinoma of the digit from ray resection to wide local excision and flap coverage

BACKGROUND

Merkel cell carcinoma is a rare cutaneous neuroendocrine neoplasm that typically presents on the head and neck. Merkel cell carcinoma (MCC) of the digits is rare, and thus limited treatment options have been presented.

METHODS

In contrast to the current treatment recommendation of ray resection of the affected digit, two patients were treated by sentinel node biopsy, wide local excision, and flap coverage of the defect.

RESULTS

No local recurrences or metastases have been seen 24 months postoperatively.

CONCLUSION

We suggest that the paradigm of ray amputation of a digit affected by MCC should evolve to initial treatment with a sentinel lymph node biopsy (SLNB) with subsequent local excision with wide margins and local flap coverage.

Composite V-Y advancement flaps for cover of distal defects on the dorsum of multiple digits

We describe the use of single large V-Y flaps of the dorsum of the hand with extension into the digits for cover of distal defects on adjacent digits in two patients.

Merkel cell tumour of the finger

Merkel cell carcinoma (MCC) is a rare primary neuroendocrine tumour. Biologically aggressive, it may be difficult to treat. We report a case of MCC on the dorsal base of the left second finger and we discuss its treatment and prognosis.

Extended reverse dorsal metacarpal artery flap: clinical experience and donor site morbidity

Extended reverse dorsal metacarpal artery (RDMA) flaps use the skin from the dorsum of the hand to cover defects of the long fingers up to the distal phalanx. The authors present a series of 12 patients who underwent closure of defects of the long fingers with these flaps. As relevant literature is scarce, special emphasis was put on donor site morbidity. Active and passive total range of motion (TRM) and pinch grip strength of the finger neighbouring the reconstructed one were evaluated and compared to the corresponding finger of the contralateral hand. The donor site was furthermore evaluated for cosmetic appearance and pain. There was no statistically significant difference for active and passive TRM. The difference for pinch grip reached statistical significance (p=0.04). Subjective evaluation of pain and cosmetic appearance by the patients revealed a mean pain value of 1.25 on a visual analogue scale (0=no pain, 10=maximal imaginable pain) and a mean estimation of cosmetic appearance of 8 (visual analogue scale, 0=worst cosmetic result, 10=best cosmetic result). In conclusion, compared to other flaps, the extended RDMA flap is a fast, secure and single-stage procedure for defect coverage on the long fingers with low donor site morbidity.

Dorsal Metacarpal Adipofascial Flaps for Palmar Finger and Hand Reconstruction

Palmar finger and hand soft tissue reconstruction using a dorsal metacarpal adipofascial flap as well as using a split-thickness skin graft obtained from a nonweight-bearing area of the sole is reported. Two cases of posttraumatic palmar hand scar contracture, 1 case of postburn palmar hand scar contracture, and 1 case of excisional palmar finger defect were repaired using this operation. Excellent results were obtained in all cases without any complications. This procedure is thought to be an effective method having many advantages and bringing about satisfactory results esthetically as well.