Two-stage toe-to-thumb reconstruction in pollicized second metacarpal and useless fingers

A case of a 25-year-old, male farm worker with a history of traumatic amputation of the right first ray, complete absence of the first metacarpal, and every phalanx of the second finger is presented. A two-stage surgical reconstruction was planned, initially, with transfer of the second metacarpal to the trapezium, creating the first web space which was covered with skin from a reverse radial forearm flap. The second stage included transfer of the right big toe to the hand with anastomoses of the first dorsal metatarsal artery to the radial artery (end-to-end) and the veins to the radial vena comitans and cephalic vein in the flap (reverse flow). Functional and cosmetic results were excellent. The physiologic considerations of reverse flow are discussed.