Vascular Anatomy of the Metacarpal Bones and the Interosseous Muscles

In Brief The utilization of the metacarpal bones and interosseous muscles in the reconstruction of the hand should be based on the vascular anatomy of the metacarpal bones and the interosseous muscles. The authors studied the vascular anatomy of the metacarpal bones and the interosseous muscles to design a split metacarpal musculoosseous flap. Eighteen cadaveric hands from 9 cadavers were included in the study. The dorsal metacarpal arteries arise from the arch and course along the metacarpal bones closer to the ulnar borders of the bones supplying their periosteum through the muscular branches. Despite the indistinct pattern of muscular supply and anastomotic branches to the palmar surface, in all hands the arteries extend constantly along the metacarpal bone closer to the ulnar border. For defects or any pathology of the carpal bones, the metacarpal bones could be split at the ulnar border distally and a split metacarpal musculoosseous flap (based proximally depending on the dorsal metacarpal artery) could be performed (or based distally along with a distal intermetacarpal anastomosis). A dissection study of 18 cadaver hands disclosed that the dorsal metacarpal arteries coursed along the ulnar aspect of the metacarpals, supplying the periosteum through the interosseous muscular branches. The anatomy suggests the feasibility of a split metacarpal myoosseous flap for carpal bone reconstruction.