Case Report: Frostbite in the tropics: abdominal pedicled flap reconstruction to prevent the metacarpal hand

The reconstructive salvage of a severely frostbitten hand in a tropical setting presents a unique challenge. We report a 59-year-old male who sustained extensive frostbite to the face, ears and bilateral hands following a Mount Everest ascent. Hyperbaric oxygen therapy (HBOT) was initiated during demarcation to optimise tissue viability. Following demarcation, dry gangrene of the right hand required amputation, revealing viable 1.5-2 cm proximal phalangeal stumps in all five digits. To avoid a non-functional metacarpal hand, reconstruction aimed to preserve digital length and metacarpophalangeal joints. A staged abdominal pedicled flap was performed, with initial flap inset and delayed pedicle division at 3 weeks, followed by syndactyly release. At 10-month follow-up, secondary debulking and contracture release were performed to optimise prosthetic use. The patient achieved stable, partially sensate digital stumps with preserved length and joint motion. This case highlights a two-stage reconstructive approach integrating HBOT and an abdominal pedicled flap to maximise anatomical preservation and functional outcome in severe pan-digital frostbite.