Introduction: Dorsal metacarpal arteries arise from the dorsal carpal arch ( a branch from the radial artery to the dorsal carpal branch the ulnar artery ), except for the first space one which is a direct branch from the radial artery at the first web. They run in the depth of the interosseous spaces of the dorsal hand, vascularizing the dorsal skin. With one of these pivot points ( between both systems) the skin of the dorsum of the hand can be transferred to distal areas on the fingers. The first and the second branches are constant, but the third and fourth dorsal metacarpal arteries may be atrophic or absent. These flaps are transposed as reverse island flaps. The dissection of the flap is easy, fast and sparet the collateral artery and nerve to the fingertip. We present 32 reverse dorsal and metacarpal flaps with a minimal 6 month follow-up. These flaps were used to cover defects proximal and distal to the interphalangeal joint with bone-, joint-or tendon exposure. The average diameter was 2.5 cm.

Results: We observed no flap necrosis. There was a minimal donor site morbidity with primary closure or skin graft in all patients. We describe the flap size, different pivot points and complications. These flaps combine the advantages of an extended skin paddle and a versatile pivot point on the phalanx.

Discussion: The need for prolonged immobilisation period of the digits in awkward positions is eliminated and the incidence of joint stiffness is reduced, the reconstruction is performed in one stage and primary skin closure is achieved. When conventional local flaps are inadequate, this fast and simple procedure should be considered for its reliability and low associated morbidity. It uses donor tissue identical in color, texture and thickness which renders acceptable cosmesis and hand function. The reverse dorsal metacarpal islands flaps provide ideal and reliable coverage of the dorsum of the proximal interphalangeal joints and medium phalanx of the second and third fingers often with primary closure of the donor site.