الفهرس 
Anatomy of dorsum of handOnly 14 pages are availabe for public view
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Abstract
In the past few decades, dorsal flaps of the hand were usually chosen by plastic surgeons to repair defects of the hand or the fingers. The reason may be the presence of different therapeutic principles that are imperative for surgeons to follow. Accordingly, the dorsum of the hand is a very good local donor site for harvesting arteries to repair distal digital defects because of its rich, complex arterial blood supply. Reconstruction of complex soft tissue defects of the hand is a challenging problem. It is very important to reconstruct these defects using sensate flaps. The use of local tissue gives the best match and is preferred wherever possible or available. These include local transposition and advancement flaps of the residual thumb skin from its volar or dorsal aspect, the traditional cross finger flap and the neurovascular heterodigital island flaps
Soft tissue defects distal to the PIP joint in the 2nd to 5th fingers always present a challenging problem for plastic surgeons. Despite the availability of various methods to solve this problem, surgeons are still exploring the most safe, simple and reliable options. Various reconstructive procedures have been described for digital defects reapir, including V-Y advancement flap, a rotation flap, or a reverse digital island flap. However, most regional and local flaps are indicated for coverage of small or moderate sized defects. The main disadvantage of the digital artery flaps is sacrificing the main artery of the finger and can only cover
Summary
112 a small area of wound defect. Moreover, donor site morbidity and skin grafting present an aesthetic unsatisfaction for the patient. The main aim of this study was to assess effect of modifications of dorsal metacarpal artery flap on survival of the flap and to compare this value with previous study of classic DMA flap. This was an intervention study was conducted at Menoufia University hospital and Shebeen El-Kom teaching hospital including twenty-one patients with different soft tissue defects or contractures of fingers who come to Menoufia University Hospitals the duration of the study ranged from 6-12 months.
The study included 17 males (81%) and 4 females (19%), their age ranged from 8.0 to 57.0 years (mean ±SD 35.38 ± 13.14); Included 11 case >35 year and 10 cases <35 year.12 of cases at Urban and only 9 cases at rural.
11 (52.4%) as crush injury, 4(19%) as incised injury, 1(14.8%) as Hot crush injury, 2(9.0%) as Electrical saw injury, 2(9.0%) as High-voltage electrical injury and 1(4.8%) as contracted scar.
11 (52.4%) at Right and 10(47.6) at left site
42.9% is in index finger, 23.8% in middle finger, 23.8% in ring finger, and 9.5% in little finger, on the other hand, and as regard level, 47.6% in middle and distal phalanx, 42.9% in distal phalanx indices, and 9.5% is in middle phalanx.
There is no accompanying injury for half of cases 10 (47.6%), 3 (14.3) of cases had with injury Extensor defect.
Summary
113
12 (57.1%) of cases had made flap <10 cm2, 9 (42.9%) of cases had made flap ≥10 cm2. Ranged from 4.5 to 15 with Mean ± SD. (9.31 ± 3.49).
38.1% is in third intermetacarpal space, 33.3% in second Intermetacarpal space, and 28.6% in fourth Intermetacarpal space.
Furthermore, as regard additional reconstruction; 28.6% had no additional reconstruction, 4.8% used K-wire fixation, 4.8% with secondary tendon, 19% with primary tendon, 9.5% with tendon repair, 4.8% with collateral ligament repair, 9.5% with DIP joint fusion, and 9.5% with Nerve repair.
95.2% survived, 71.4% had no venous congestion.
There was no statistically significant difference between Survival as regard Sex, Age, Residence, Injury type, Site, Digit and Level.
There was no statistically significant difference between Survival as regard accompanying Injury, Flap Size (cm2), Intermetacarpal space, Additional reconstruction and venous congestion.
There was no statistically significant difference between presence or absence of venous congestion as regard Sex, Age, Residence, Injury type, Site, Digit and Level.
There was no statistically significant difference between presence or absence of venous congestion as regard Accompanying Injury, Flap Size (cm2), Intermetacarpal space, Additional reconstruction and Survival.
Summary
114
Based on our findings, we recommend for further studies on larger sample size and on large geographical scale to emphasize our conclusion.