Osteo-Cutaneous Reconstruction of the Thumb by Radial Composite Flap

Abstract

Background. One of the possible ways of the thumb reconstruction when it is lost at the level of the middle third of the ray is osteo-cutaneous reconstruction, which today is carried out by transplantation of the blood-supplied composite tissue complex, which allows for reconstruction of the lost thumb without the risk of the bone graft resorption.
 The aim — to evaluate the effectiveness of osteo-cutaneous reconstruction of the thumb using a blood-supplied tissue complex based on the radial artery. The study is based on the results of the treatment of 27 patients who underwent the thumb reconstruction with a radial osteo-cutaneous tissue complex performed according to the G. Foucher’ technique. The average age of the operated patients was 44±12.7 years. The island tissue complex was used in 22 patients; in 5 cases, a free flap from another forearm was transplanted.
 Results. Long-term results were evaluated one year after reconstruction. In all cases, good functional results were achieved with an average DASH score of 44.4±10.6 points. The best results were obtained in patients with a stump at the base of the thumb proximal phalanx due to the preservation of the metacarpophalangeal joint mobility, the average volume of movements of which was 45°. When using Littler’s flap, it is possible to achieve a 2PD of the working surface of the restored thumb within 7.5±0.9 mm. Otherwise, only the protective sensitivity is restored.
 Conclusions. The osteo-cutaneous reconstruction of the thumb when it is absent at the level of the middle third of the ray is an effective method of reconstruction if it is impossible to use other microsurgical methods, such as transplantation of the second toe or the fragment of the great toe.