The Holevich flap revisited: a comparison with the Foucher flap, case series

Abstract

The first dorsal metacarpal artery flap was initially described by Hilgenfeldt, it was designed as a racquet flap by Holevich and modified as an island flap by Foucher and Braun. The objective of the present is to compare the Holevich flap and the Foucher flap in terms of venous congestion and flap necrosis. From 2009 to 2013, ten first dorsal metacarpal artery flaps were performed at our hospital's hand unit. Five of the flaps were Holevich type flaps and five of the flaps were Foucher flaps. There were seven men and three women. The mean age was 47 years for the Foucher flap group (17-67 years), and 48 years for the Holevich flap group (36-61 years). Strength, static two tips discrimination, ranges of motion, satisfaction, cold intolerance, pain, flap congestion and flap necrosis were recorded for both groups. Similar values of strength, pain, range of motion and two tips discrimination were found on both groups. There was a higher incidence of flap congestion and necrosis on the Foucher flap group (two thumbs underwent partial flap necrosis and two underwent venous congestion in three patients). There was also a higher incidence of cold intolerance in the Foucher group (two patients exhibited moderate cold intolerance and one exhibited a severe cold intolerance). A proper statistical analysis was not possible due to the size of the case series. In this small case series the Holevich exhibited less flap necrosis, less venous congestion, and less incidence of cold intolerance than the Foucher flap.

Keywords: Foucher; Holevich; Kite Flap; Thumb; Venous Congestion.