First Toe-to-Hand Transfer and the Forearm Radial Flap as Chain-Linked Flaps for Thumb Reconstruction After Amputation

Abstract

Complex injuries of the hand with soft tissue defects and concomitant thumb amputation require an elaborated surgical approach to address both soft tissue coverage and thumb reconstruction. In our experience, for this kind of lesions, the all-in-one reconstruction seems to be best option especially in young patients. This case refers to an 18-year-old male presenting a complex circular saw injury of his left hand, with thumb, index finger and fifth digital ray amputation, and palmar and dorsal soft tissue defect, involving both common vasculo-nervous pedicles (VNP) for third and fourth web spaces, flexor digitorum profundus (FDP) of the third finger, and both flexor digitorum superficialis (FDS) and FDP of the fourth finger.

After careful debridement, FDP repair of the third and fourth finger, revascularization of the fourth finger, as well as reinnervation of the third and fourth finger was undertaken. Finally, a contralateral radial forearm flow-through flap was simultaneously used for coverage of the palmar and dorsal soft tissue defect of the hand and for thumb reconstruction using a big toe transfer.

The postoperative evolution was uneventful, and the functional and morphological results were very good, with the regain of 70% from the hand functionality. Aesthetic results were considered satisfactory for both donor and recipient sites.