Free first dorsal metacarpal artery flap for nasal lining

Protection of vital structures is an important aspect of reconstructive surgery. The size and location of defects vary considerably, making wound closure an ever-constant challenge for reconstructive surgeons. In the realm of nasal reconstruction, surgical defects can be quite small and poorly accessible, and local tissues are often unsuitable for use. In these situations, free-tissue transfer provides a reliable means for reconstruction. Small defects, however, require small flaps for closure. Donor sites for small, thin flaps that can be utilized for microsurgical reconstruction are quite limited. One unique flap that provides thin, supple tissue for reconstruction is the first dorsal metacarpal island flap. We present the utilization of microsurgical free-tissue transfer of a double-island free first dorsal metacarpal artery (DMA) flap for reconstruction of a nasal septal and vestibular defect in the course of a subtotal nasal reconstruction.