Composite osteo-tendino-cutaneous reverse radial forearm flap for complex thumb reconstruction: A case report

The reverse radial forearm flap is a powerful tool in the reconstruction of dorsal hand defects. Traditionally, only fasciocutaneous tissues perfused by retrograde flow through the radial artery are harvested to resurface the dorsal hand. Including vascularized tendon and bone within the flap, however, makes reconstruction of complex composite defects in a single stage possible, thereby decreasing morbidity and improving functional outcomes. The current case describes a single-stage reconstruction of a composite amputation defect of the dorsal hand and thumb with loss of dorsal and first webspace soft tissue, the metacarpophalangeal joint, and a segment of the extensor pollicis longus tendon. Reconstruction was performed using a chimeric osteo-tendino-cutaneous reverse radial forearm flap with vascularized intrasynovial flexor carpi radialis tendon. The flap healed with no complications, and the patient returned to work two months postoperatively. At five months follow-up, the patient was still working and could abduct his thumb to the proximal interphalangeal flexural crease of his small finger. Seven months postoperatively, he underwent scar revision for hypertrophic scarring and z-plasty of the first web space to further improve thumb abduction.