Reverse radial forearm flap as a source of soft tissue and blood supply for thumb reconstruction

Soft-tissue deficiency is sometimes a major problem in thumb reconstructive cases with toe-to-thumb transfer. In the patient presented, a reverse radial forearm flap was used to provide a vascular pedicle for anastomosis with the second toe vessels. The flap also provided soft-tissue coverage for the metatarsal bone of the transferred toe. The radial artery and concomitant vein were used for the dorsalis pedis artery and vein anastomosis. The skin island of the forearm flap was wrapped around the transferred metatarsal bone. Using this technique, two limiting problems in toe-to-hand transfers were solved at the same time. In the crushed hand, sometimes it is not possible to find enough soft tissue and a good vascular pedicle for a new thumb, and this option seems to be a reasonable choice.