Introduction
The first dorsal metacarpal artery perforator (DMCAP) flap is frequently used to cover exposed bone,
tendon and neurovascular structures in the hand after trauma and burns. The size and width of
DMCAP flap is limited and rotation arc generally lets to cover defects up to middle phalanx.
Expansion of the DMCAP flap has not been reported in the literature and this technique might be
solution to increase flap viability and size in order to cover defects up to distal phalanx.
In this study, we will describe utilization of tissue expander to first DMCAP and present a case of
electric burns in with flexor contracture.
Methods:
A nine-year-old male patient applied to our clinic with the complaint of inability to extend the second
finger of the left hand after an electrical burn. Physical examination revealed flexor contracture in the
distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints. Reconstruction was planned for
the patient with a two-session expanded first DMCAP flap.

In the first session, a 16 cc 5x3 cm tissue expander placed through a 3 cm vertical incision at the fifth
metacarpal level. From the second postoperative week, the tissue expander was inflated with 1 ml of
isotonic three days a week. Six weeks later, the DMCAP area was enlarged by giving 45 cc saline.
Results
In the second session, contractures at the level of the left hand 2nd finger DIP and PIP were excised..
Left hand 2nd finger was fixated in extension with K-wire. 9x3 cm DMCAP flap was elevated by
dissection over the paratenon and the pedicle was preserved. The flap was adapted to the defect area
on the volar face with 180-degree rotation angle. The flap donor site was closed primarily.
There were no complications in the post-operative period. K-wire was removed at 6 weeks
postoperatively. The patient was referred to the physical therapy.

Conclusion
In cases where the tissue defect cannot be closed with loco regional flaps, extra tissue can be provided
by free flaps or using tissue expanders. Primary closure of the donor area, appropriate flap thickness
for the finger, and aesthetically pleasing results are among the advantages of the expanded DMCA
flap.. However, in tissue expander applications in the upper extremity, the patient should be followed
closely, and pain and finger circulation should be constantly questioned.
Applicability of Research to Practice: Flap size and length can be increased and total volar side of a
finger can be covered with this expanded flap.

P.124 Reconstruction of finger contracture with an expanded first dorsal metacarpal artery perforator flap

Dear friends and colleagues,

We will be pleased to welcome you in Turin (Italy) for the 19th European Burns Association´s Congress in 2022. Italy is honored to hold the meeting of the European Burns Association for the second time, after Verona in 1995. Turin is easily reachable from everywhere in Europe, either travelling by car, train or choosing flight connections. During the meeting, held in the renewed industrial center of the main Italian historical automotive factory (i.e. Lingotto-FIAT), we will meet international burn specialists, focusing on standards of care, progresses in burn treatment, strategies to face disaster situations, with a special attention to education of younger colleagues. However, in your spare time, you might enjoy the sweet days of Italian late summer, simply wandering in the green parks and gardens along the two rivers which cross the city, or you might decide to discover the numerous art galleries, churches, palaces, libraries, walking across elegant squares and large boulevards, passing through centuries of art and history; finally, you may choose to immerse yourself in some of the most exciting museum experiences, such as the Cinema Museum and the Turin’s Egyptian museum.

Looking forward to seeing you all in Turin for the 19th European Association´s Congress in 2022!
Maurizio Stella, Congress President, Turin Burn Centre