Reverse first dorsal metacarpal artery flap repair of a right thumb epidermis granuloma: A case study

Abstract

One case of epidermal granuloma of the right thumb was diagnosed by color Doppler ultrasonography and pathologic examination. Epidermal granuloma resection and reverse island skin flap transplantation were performed to determine the therapeutic effect of a reverse first dorsal metacarpal artery flap repair of an epidermal granuloma of the right thumb. After effective intravenous combined general anesthesia, the skin in the surgical field was disinfected and sterile drapes were placed. An oblique incision was made over the underlying epidermis granuloma. The right palm of the reverse first dorsal metacarpal artery flap was chosen. The pedicle was carefully protected, and the flap was transplanted to the defective skin area. The incision was sutured after hemostasis. A palpable mass with the dimension of the right thumb of the patient was measured by color Doppler ultrasonography and physical examination pre-operatively. The palpable mass was oval in shape and protruded from the skin surface. The palpable mass had an unclear boundary with the surrounding skin and therefore the skin should be removed. If the tendon is exposed after the resection, complications may occur after operation, such as skin necrosis and tendon exposure. Intra-operatively, the mass was 1.5×1.0 cm in size and multi-cystic. The boundary between the palpable mass and the surrounding skin could not be discerned. The skin area (1.5×1.0 cm in size) was completely invaded by the palpable mass, which was closely adhered to the surrounding tissue. The palpable mass was carefully dissected with appropriate protection to the finger nerves and arteries. The palpable mass and affected skin were completely removed, leaving a defect area of ~1.5 ×1.0 cm without skin. The reverse first dorsal metacarpal artery flap was used to repair the defect area. The repaired flap had a good blood supply and peripheral circulation. The operation was successful, and the anesthesia effect was satisfactory. Treatment of a thumb epidermis granuloma with reverse first dorsal metacarpal artery flap was shown to be a feasible strategy with a broad clinical application.

Keywords: granuloma; reverse first dorsal metacarpal artery flap; thumb epidermis.

Figure 1.

Epidermal granulomatectomy and reverse island flap transplantation. (A) Frontal view of thumb mass; (B) lateral view of thumb mass; (C) dorsal skin defect area after resecting mass; (D) palmar skin defect area after resecting mass; (E) designing and cutting equal proportion skin flaps; (F) transferring pedicled skin flap to skin defect; (G) covering defect area with reverse flap and observing the length of the pedicle; (H) covering defect area and observing the repaired flap having good blood supply; (I) putting the flap back and observing the length and width of the pedicle and blood supply of the flap.

Figure 2.

Pathological analysis of granuloma annularis. Pathological image with (A) 4 multiples, (B) 10 multiples, and (C) 40 multiples under a microscope.

Figure 3.

Complete survival of flap transplantation after operation. (A) Frontal view, (B) oblique view, and (C) lateral view of complete survival of flap after 2 weeks.