Distal Forearm Perforator Flaps in Thumb Reconstruction

Twelve distally pedicled forearm perforator flaps were used in 11 patients treated between March 2000 and December 2004. The flaps had different forms: 9 were adipocutaneous and 3 were fasciocutaneous, including 2 island flaps. Eight unknown (not radial) artery perforator flaps in 7 patients, aged 2 to 20, with congenital hand defects, and 4 radial artery perforator flaps in 4 patients aged 15 to 28 after hand trauma, were used.

In the congenital defects (mainly types IV and V of thumb hypoplasia according to Blauth), adipocutaneous flaps were harvested in ratios from 5:1 to 7:1. The ratio of the remaining flaps was more regular. The flaps were incised as triangular in a distal or oval area of the proximal forearm. Retrograde elevation was performed, leaving cutaneous nerves and cephalic vein intact. One male patient, 28-years-old, was treated emergently because of an extensive damage of the thumb dorsal tissues with destruction of extensor tendons. The skin, fascia, and tendons were reconstructed using a fasciocutaneous radial artery perforator island flap, including a vascularized palmaris longus tendon graft.

Seven of these flaps healed without any problems. In four of them, superficial maceration of the distal part of the skin was observed. One fasciocutaneous flap elevated from the proximal forearm presented partial skin necrosis in the middle of the island. Following excision of necrotic skin, the wound healed spontaneously after a few weeks.

Distal forearm perforator flaps were used as a one-stage procedure or a part of more complicated procedures, e.g., toe-to-hand transfer. All reconstructions using these flaps were successful. On the basis of presented clinical material, these flaps may be a method of choice in treatment of several congenital deformations and injuries of the hand.