J Korean Orthop Assoc.  2009 Apr;44(2):226-232.

Reversed Osteocutaneous Radial Forearm Island Flap for Crushing Injury and Open Fracture of the Thumb in Hand

• Lee YK
• Woo SH
• Kim JY
• Park JK
• Lee HH

Abstract

PURPOSE
To report the outcome of a reversed osteocutaneous radial forearm flap for a thumb reconstruction. MATERIALS AND METHODS: Five patients who underwent a reversed osteocutaneous radial forearm island flap for a thumb reconstruction between 2001 and 2005 were reviewed retrospectively. They were all males with a mean age at the time of surgery of 45 years. The types of thumb defects, size of the flap, length of the radius harvested, time to union, the range of motion of the thumb, grip and pinch strengths, and complications were analyzed. RESULTS: The mean size of the transferred radial forearm flap was 58.4 cm2. The mean length of the harvested radius was 4.4 cm. All flaps survived completely. The mean interval required to obtain bone union was 2.8 months. The mean ROM of the thumb was 47degrees. The postoperative mean grip strength was 94 lbs and the mean pinch power was 14.6 lbs. Mean moving two-point discrimination on the flap was 13 mm. There were no complications. All 5 patients were satisfied with the reconstructed new thumb. CONCLUSION: A reversed osteocutaneous radial forearm island flap is a useful procedure for reconstructing of a combined defect of the thumb.

Keyword

Reversed radial forearm osteocutaneous flap; Thumb reconstruction

MeSH Terms

Discrimination (Psychology)
Forearm
Fractures, Open
Hand
Hand Strength
Humans
Male
Pinch Strength
Radius
Range of Motion, Articular
Retrospective Studies
Thumb

Figure

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  Fig. 1 (A, B) Preoperative views of the left thumb show severe crush injury on the soft tissue and comminuted fracture of the proximal phalangeal bone and metacarpal bone. (C) The osteocutaneous island flap, which is based on the pedicle of reversed radial artery and vena comitantes, includes 8×8 cm of skin flap in size as well as 6 cm of radius in length. (D-F) Postoperative 20 months later.

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  Fig. 2 (A, B) Preoperative views of the right thumb show severe crush injury on the soft tissue and comminuted fracture of the distal and proximal phalanges. (C) The osteocutaneous island flap, which is based on the pedicle of reversed radial artery and vena comitantes, includes 8×4 cm of skin flap in size as well as 4 cm of radius in length. (D-F) Postoperative 24 months later.

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  Fig. 3 (A, B) Preoperative views of the left thumb show severe crushed incomplete amputation at the level of proximal phalanx head. (C, D) Postoperative views after revision amputation and debridement. (E) The osteocutaneous island flap, which is based on the pedicle of reversed radial artery and vena comitantes, includes 14×5 cm of skin flap in size as well as 3 cm of radius in length. (F-H) Postoperative 48 months later.

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