Chimeric tricomposite flap from the second dorsal metacarpal artery

Reconstructing multi-tissue defects in the finger remains a significant challenge in hand surgery. We present the case of a 37-year-old man with segmental loss of bone, skin and extensor apparatus on the dorsal aspect of the index finger. A single stage reconstruction was successfully performed using a pedicled chimeric flap based on the second dorsal metacarpal artery combining skin paddle, second metacarpal base bone and the extensor indicis proprius. At 12 weeks, proximal interphalangeal joint fusion was achieved and the skin flap healed uneventfully. The patient regained full extension and 20° of active flexion at the distal interphalangeal joint. To our knowledge, this specific chimeric flap has not been previously described in the literature. This technique provides a versatile, single-stage solution for complex dorsal finger reconstruction, minimizing morbidity and optimizing functional outcomes.