American Association of Plastic Surgeons

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First Dorsal Metacarpal Island Free Flap for Salvage of Nasal Reconstructions
Emily Harris, MD1, ROBERT LEE WALTON, Jr., MD2.
1Emily Harris, ST. JOSEPH HOSPITAL, IL, USA, 2NORTHWESTERN UNIVERSITY, CHICAGO, IL, USA.

PURPOSE: The First Dorsal Metacarpal Artery (FDMA) Island flap has demonstrated utility as a pedicled and free flap for thumb and hand reconstruction. Its use as a free flap for defects outside the upper extremity is uncommon. We first described successful application of a FDMA free flap for salvage of a nasal reconstruction in 2005. We report our subsequent experience with FDMA free flaps for salvage of nasal reconstructions.
METHODS: A retrospective review of FDMA free flaps for nasal reconstruction for the period 1997 through 2018.
RESULTS: Seven patients were treated: 3 males and 4 females. Age averaged 60 yrs (range 45-71yrs). Follow-up averaged 12.4 yrs (range 1-18 yrs). Defects reconstructed were primarily columella (6/7 patients). One patient was treated for a nasal cutaneous fistula secondary to osteomyelitis of an irradiated nasal bone graft. There were no flap failures or major complications. Donor sites exhibited excellent healing with no impairment of hand motion. FDMA flaps provided stable coverage of the defects yielding aesthetic and functional results.
CONCLUSION: This paper highlights an alternative application of the free FDMA flap, commonly allocated to hand reconstruction. Its small size, thinness, consistent anatomy, and reliability provides a unique resource for microsurgical soft tissue restoration of specific element defects arising during the course of total and subtotal nasal reconstruction where local tissues are either unavailable or their use is undesirable.


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