الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Hand is an important part of the body with unique characteristics. Soft tissue defects and deformities of the hand are caused by trauma, burn, infection and after tumour excision. These defects if were not managed properly, they would cause a temporary or permanent disability in the hand, so over the past decades, many reconstructive options have evolved to insure an optimal soft tissue coverage of the hand that maintain sensibility, durability and function of the hand.
Our prospective study was done on twenty patients with dorsal digital or web space defects or deformities and are reconstructed using DMAP flap.
Quaba and Davison first described in 1990 a flap derived from the dorsal intermetacarpal skin of the hand spanning the level of the metacarpal heads to the distal wrist and is based on a cutaneous perforator arising directly from the dorsal metacarpal artery or from the communicating branch between the palmar metacarpal artery and the DMA. The perforator is located about one cm proximal to metacarpal head or 1.5 cm proximal to the leading edge of the web space just distal to juncture tendinum. Venous drainage of the flap is achieved by the connective tissue surrounding the perforator which has a rich venous network that provides sufficient venous return for the flap.
The flap has a long arc of rotation which allows it to cover dorsal and lateral or palmar finger soft tissue defects proximal to fingertip, dorsal metacarpal and metacarpophalangeal areas and web space reconstruction as in syndactyly (graft –free repair) and post burn deformity.
DMAP flap provides an ideal coverage with good aesthetic and functional outcomes for the small to medium sized defects of the dorsum of the fingers and web spaces as the defect is covered with tissues of similar type with minimal donor site morbidity
Many injuries like crush-avulsion, high energy trauma which potentially affect flap donor site make the flap unreliable and contraindicated to be used.
Although it is a reliable flap, flap congestion or ischemia can occur resulting from tunnelling, tight wound closure, short pedicle or kinking of the pedicle. Donor site of the flap is usually closed directly, rarely needs skin graft and may be complicated by hypertrophic scar, keloid formation, wound dehiscence hyper or hypo pigmentation.