The first digital ray is very important in the functional economy of the hand. Its absence or damage can diminish the functional ability of the hand up to 50%. That’s why its reconstruction close to normal is mandatory. Sometimes, in case of missing bone associated with a soft tissue defect, complex reconstructive solutions become instrumental to achieve the desired functionality. This case refers to a 17-year-old female referred to our department 2 weeks after a crush injury of the right hand, presenting a large soft tissue defect over the dorsal aspect of the thumb, hand, and distal forearm, with exposure of the necrotic previous fractured first metacarpal bone, necrotic base of the first phalanx, and remaining proximal part of the previously fractured trapezium. After careful debridement, a free composite serratus anterior-rib flap was used to reconstruct both the first metacarpal bone and the skin defect. The muscle was covered with split-thickness skin graft. The long extensor tendon of the thumb was reconstructed using the extensor indicis proprius tendon as a functional tendon transfer.
The postoperative evolution was uneventful, with regain of about 85% of the functional capacity of the hand and a reasonable aesthetic result for both donor and recipient sites.
Crush injury Hand First metacarpal Soft tissue defect Compound serratus anterior-rib flap
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