Reconstruction of Multiple Metacarpals Using Free Seratus with Vascularized Ribs in Soldiers Following High Energy Explosive Injuries

Introduction: Following injuries sustained from Improvised Explosive Devices (IED) in Afghanistan, we report the reconstruction of multiple metacarpals in two soldiers’ hands using the free seratus muscle flap with vascularized ribs.

Methodology and Material: A free seratus muscle flap with vascularized ribs was taken for each of the two soldiers from the contralateral side of the thorax from their injured hands respectively. Each flap was anastamosed proximally on to the radial artery in the forearm.

Results: The first patient has gone on to have functioning digits in his left hand, with the plan to reconstruct the extensor tendons in his hand, although currently the patient has declined any further surgery.

The second patient regrettably lost the flap 10 days post-reconstruction secondary to massive exsanguination from a brachial artery pseudo aneurysm. This resulted from a rare fungal infection that caused necrotic arteritis.

Conclusions: A review of the literature found very few reconstructive options for multiple metacarpals, with the only other option described aside from the seratus with rib ‘Eve‘ flap, being a free fibula flap. Given that these soldiers had lost their lower limbs during the same explosions that had injured their hands, this flap was not an option. The seratus muscle flap with vascularized ribs is a very versatile and useful flap when reconstructing the metacarpals.