Also see the Dr Vinita puri & Dr Nilesh SHENDE Paper First Dorsal Metacarpal Artery Flap a Workhorse for Reconstruction of Selected Small Defects of the Hand Turkish Journal of Plastic Surgery 27(3):p 98-103, Jul–Sep 2019. | DOI: 10.4103/tjps.tjps_71_18

1. FDMA- FIRST DORSAL METACARPLE ARTERY FLAP ( kite flap)
 This is a FASCIOCUTANEOUS FLAP first described by Holevich in 1963.
 It was modified and used as a neurosensory island flap by Foucher and Braun in 1979.
NERVE SUPPLY:-
TERMINAL BRANCHES OF THE SUPERFICIAL RADIAL NERVE
ARTERIAL SUPPLY:-
DOMINANT PEDICLE: FIRST DORSAL METACARPAL ARTERY
Length: 3–6 cm
Diameter: 0.5–1.0 mm
SECONDARY: BRANCH(ES) OF THE CEPHALIC VENOUS SYSTEM
Length: range 3–6 cm
Diameter: range 1–2 mm
MINOR PEDICLE: COMMUNICATING PERFORATORS FROM PALMAR ARTERIAL
VENOUS DRAINAGE
PRIMARY: VENOUS COMITANTES OF THE FDMA SYSTEM
Length: 3–6 cm
Diameter: 0.2–0.3 mm

2. FLAP DIMENSIONS
 Length: 3 cm (range 2–5 cm)
 Width: 2 cm (range 1.5–3 cm)
 Thickness: the thickness of the dorsum of the hand
FLAP COMPONENTS: SKIN AND SUBCUTANEOUS TISSUE
ARC OF ROTATION
FOR DORSAL DEFECT FOR VOLAR DEFECT

3. INDICATIONS:-
 For resurfacing either volar or dorsal defects of the distal thumb as far distal as the interphalangeal (IP) joint.
 It can be used to cover the ulnar surface of the dorsum of the hand and the wrist, or the palm up to the third metacarpal.
 It is useful for first web space reconstruction following contracture, and it can provide soft-tissue coverage of the index finger up
to the level of the proximal phalanx.
 There are no specific age restrictions provided that the radial artery is not involved with atheroma. It can be used in both acute
trauma and elective reconstruction.
CONTRAINDICATIONS:-
 A radial artery injury in the anatomical snuffbox.

4. TECHNIQUE OF HARVEST
PREOPERATIVE EXAMINATIONS AND MARKINGS
 Preoperative Doppler examination for the presence of vessels is mandatory
 mark the course of the vessels on the skin, because they are always located
more radially than presumed
PATIENT POSITION
 Supine with arm on arm table + tourniquet use during harvest
DISSECTION
 Incise skin along the markings along the second metacarpal
 incise the interosseous muscle fascia
 preserve the intermuscular septum and raise the fasciocutaneous flap, including
the fascia
 take care to include the nerve and create a de-epithelialized pedicle
 leave approximately 0.5–1 cm of fatty tissue around the artery
 preserve the paratenon above the extensor hood
 open the tourniquet and check for perfusion
 inset the flap at the recipient site and wait for normal perfusion to occur
 treat the skin graft donor site with a medium- or full-thickness skin graft
 be careful when tunnelling.

5. THANK YOU.