Triple Chimeric Flap Based on Anterior Tibial Vessels for Reconstruction of Severe Traumatic Injuries of the Hand with Thumb Loss

Abstract

Background: 

Reconstruction of severe traumatic injuries of the hand with digit loss may require multiple procedures over a prolonged period. The authors present a clinical series of patients in which these types of injuries were reconstructed in a single operation.

Methods: 

A chimeric flap based on the anterior tibial vessels is described. A total of three free tissue transfers included an anterior tibial flap, a dorsalis pedis flap, and a great toe wraparound flap. These triple flaps were transferred to resurface the defects of the mutilated hand, which was involved in the thumb, first web space, volar palm, thenar eminence, or radial aspect of wrist. The cumulative size of the defects ranged from 9 × 11 cm to 12 × 18 cm.

Results: 

From 2002 to 2007, six patients with multiple defects of the hand and thumb underwent reconstruction using the described technique. The donor sites were covered by means of split-thickness skin grafting. All flaps survived and patients were satisfied with the functional and aesthetic outcome postoperatively at 6 to 12 months’ follow-up. The average improvement of thumb opposition was 4.8 on the Kapandji scale. Sensory recovery of the thumb tip of S3⁺ was achieved. There were no major donor-site complications.

Conclusion: 

A chimeric flap based on the anterior tibial vessels is an excellent method of reconstruction of severe multilevel injuries of the hand, including thumb loss.