Vascularized First Dorsal Metacarpal Artery-Based Adipofascial Flap to Augment Multiple Zone VII Extensor Tendon Repairs after Glass Laceration: A Case Report.

Introduction: Multiple extensor tendon repairs may be complicated by adhesions, retear, stiffness, and loss of range of motion, especially when supervised hand therapy and regular follow-up are difficult. We report a simple technique using a vascularized adipofascial flap based on the first dorsal metacarpal artery to cover the repair site and create a biologically favorable gliding tunnel. Case Report: An 18-year-old manual worker sustained glass lacerations over extensor zone VII of the wrist with complete transection of the thumb and finger extensor tendons. The tendons were repaired primarily and augmented with a vascularized adipofascial flap based on the first dorsal metacarpal artery, which was wrapped around the repair site as a gliding tunnel. At 6 weeks, the patient had full active finger and thumb extension and flexion without lag, and he returned to heavy activity by 12 weeks. Conclusion: This local flap may provide a low-cost, vascularized interface that supports tendon healing and limits adhesion after complex dorsal wrist tendon injury, particularly where supervised hand therapy access is limited.