Thinned chimeric radial collateral artery perforator flap in complex distal thumb reconstruction

Area of Science:

• Microsurgery
• Orthopedic surgery
• Plastic surgery

Background:

• Thumb defects involving bone and soft tissue present significant reconstruction challenges.
• Traditional surgical methods often yield unsatisfactory outcomes for these complex cases.

Purpose of the Study:

• To evaluate the efficacy of thinned chimeric radial collateral artery (RCA) perforator flaps for thumb reconstruction.
• To assess functional and cosmetic outcomes following this microsurgical technique.

Main Methods:

• Microsurgical reconstruction using 13 thinned chimeric RCA perforator flaps with thinned skin paddles and humeral bone segments.
• Inclusion of the posterior cutaneous nerve of the arm for sensory restoration.
• Evaluation of defect and flap sizes, bone fragment dimensions, and post-operative outcomes including Kapandji opposition score and two-point discrimination.

Main Results:

• All flaps survived, with bone union achieved in all cases. Average flap thickness post-defatting was 3.5 mm.
• Mean thumb opposition score was 6, and mean sensation recovery was 7.5 mm.
• Cosmetically acceptable results were achieved, with no further flap revisions needed.

Conclusions:

• Thinned chimeric RCA perforator flaps represent a beneficial microsurgical alternative for complex thumb defects.
• This technique effectively addresses both bone and soft tissue loss, offering a viable solution where traditional methods fall short.