Thumb reconstruction via a pedicled flap based on the superficial palmar branch of the radial artery from the wrist crease area

Da-Wei Zheng, Zhang-Can Li, Rong-Jian Shi, Feng Sun, Li Xu, Kui-Shui Shou
Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS 2015, 68 (11): 1581-7

BACKGROUND: The free flap based on the superficial palmar branch of the radial artery (SPBRA) has been extensively reported. A reversed pedicled flap based on the SPBRA, harvested from the wrist crease area, can be a potential candidate for the reconstruction of the soft-tissue and artery defects in the thumb.

METHOD: Between January 2012 and October 2013, this flap was used in seven patients to reconstruct soft-tissue defects in the thumb. In three patients, blood circulation of the thumb was reestablished using flow-through flaps. The Michigan Hand Outcomes Questionnaire was used for patient self-evaluation.

RESULTS: In one patient, the surgery was abandoned due to blood vessel variation. All the flaps and thumbs survived in the other six patients. The wounds healed primarily. All patients were followed up for a mean of 16.5 months (range, 12-26 months). At the last follow-up, the mean static two-point discrimination was 7.3 ± 0.9 mm on the affected side and 4.6 ± 0.7 on the contralateral side. The range of motion of the metacarpophalangeal joint and the interphalangeal joint were 66.8 ± 8.4° (contralateral, 85.2 ± 3.8°) and 67.0 ± 6.9° (contralateral, 80.5 ± 5.0°), respectively. Patient self-evaluations were good in five cases and fair in one case.

CONCLUSION: The reverse island flap based on the SPBRA is feasible for soft-tissue defects and establishing blood circulation in the thumb. The donor site can be closed primarily, and the scar is inconspicuous in the wrist crease.

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