Abstract
Purpose
To report the outcome of a reversed osteocutaneous radial forearm flap for a thumb reconstruction.
Materials and Methods
Five patients who underwent a reversed osteocutaneous radial forearm island flap for a thumb reconstruction between 2001 and 2005 were reviewed retrospectively. They were all males with a mean age at the time of surgery of 45 years. The types of thumb defects, size of the flap, length of the radius harvested, time to union, the range of motion of the thumb, grip and pinch strengths, and complications were analyzed.
Results
The mean size of the transferred radial forearm flap was 58.4 cm2. The mean length of the harvested radius was 4.4 cm. All flaps survived completely. The mean interval required to obtain bone union was 2.8 months. The mean ROM of the thumb was 47°. The postoperative mean grip strength was 94 lbs and the mean pinch power was 14.6 lbs. Mean moving two-point discrimination on the flap was 13 mm. There were no complications. All 5 patients were satisfied with the reconstructed new thumb.
Figures and Tables
Fig. 1
(A, B) Preoperative views of the left thumb show severe crush injury on the soft tissue and comminuted fracture of the proximal phalangeal bone and metacarpal bone. (C) The osteocutaneous island flap, which is based on the pedicle of reversed radial artery and vena comitantes, includes 8×8 cm of skin flap in size as well as 6 cm of radius in length. (D-F) Postoperative 20 months later.
![jkoa-44-226-g001](/upload/SynapseData/ArticleImage/0043jkoa/jkoa-44-226-g001.jpg)
Fig. 2
(A, B) Preoperative views of the right thumb show severe crush injury on the soft tissue and comminuted fracture of the distal and proximal phalanges. (C) The osteocutaneous island flap, which is based on the pedicle of reversed radial artery and vena comitantes, includes 8×4 cm of skin flap in size as well as 4 cm of radius in length. (D-F) Postoperative 24 months later.
![jkoa-44-226-g002](/upload/SynapseData/ArticleImage/0043jkoa/jkoa-44-226-g002.jpg)
Fig. 3
(A, B) Preoperative views of the left thumb show severe crushed incomplete amputation at the level of proximal phalanx head. (C, D) Postoperative views after revision amputation and debridement. (E) The osteocutaneous island flap, which is based on the pedicle of reversed radial artery and vena comitantes, includes 14×5 cm of skin flap in size as well as 3 cm of radius in length. (F-H) Postoperative 48 months later.
![jkoa-44-226-g003](/upload/SynapseData/ArticleImage/0043jkoa/jkoa-44-226-g003.jpg)
References
1. Bardsley AF, Soutar DS, Elliot D, Bachelor AG. Reducing morbidity in the radial forearm flap donor site. Plast Reconstr Surg. 1990. 86:287–292.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
2. Biemer E, Stock W. Total thumb reconstruction: a one-stage reconstruction using an osteocutaneous forearm flap. Br J Plast Surg. 1983. 36:52–55.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
3. Boorman JG, Brown JA, Sykes PJ. Morbidity in the forearm flap donor arm. Br J Plast Surg. 1987. 40:207–212.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
4. Brown CJ, Mackinnon SE, Dellon AL, Bain JR. The sensory potential of free flap donor sites. Ann Plast Surg. 1989. 23:135–140.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
5. Chacha B, Soin K, Tan KC. One stage reconstruction of intercalated defect of the thumb using the osteocutaneous radial forearm flap. J Jand Surg Br. 1987. 12:86–92.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
6. Cormack GC, Duncan MJ, Lambert BG. The blood supply of the bone component of the compound osteocutaneous radial artery forearm flap-an anatomical study. Br J Plast Surg. 1986. 39:173–175.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
7. Kim KC, Lee GJ, Kim JS, Woo SH. Revisit of the utilities and indications of reversed radial forearm flap for hand reconstruction. J Korean Soc Surg Hand. 2004. 9:292–298.
8. Leung PC. Transplantation of the second toe to the hand. A preliminary report of sixteen cases. J Bone Joint Surg Am. 1980. 62:990–996.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
9. Lin SD, Lai CS, Chiu CC. Venous drainage in the reverse forearm flap. Plast Reconstr Surg. 1984. 74:508–512.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
10. Matev IB. Thumb reconstruction through metacarpal bone lengthening. J Hand Surg Am. 1980. 5:482–487.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
11. Minami A, Usui M, Katoh H, Ishii S. Thumb reconstruction by free sensory flaps from the foot using microsurgical techniques. J Hand Surg Br. 1984. 9:239–244.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
12. Morrison WA, O'Brien BM, MacLeod AM. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe. J Hand Surg Am. 1980. 5:575–583.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
13. Poppen NK, Norris TR, Buncke HJ Jr. Evaluation of sensibility and function with microsurgical free tissues transfer of the great toe to the hand for thumb reconstruction. J Hand Surg Am. 1983. 8:516–531.
14. Reid CD, Moss LH. One-stage slap repair with vascularized tendon grafts in dorsal hand injury using the "Chinese" forearm flap. Br J Plat Surg. 1983. 36:473–479.
16. Swanson E, Boyd JB, Manktelow RT. The radial forearm flap: reconstructive applications and donor-site defects in 35 consecutive patients. Plast Reconstr Surg. 1990. 85:258–266.
17. Timmons MJ. William Harvey revisited: reverse flow through the valves of forearm veins. Lancet. 1984. 2:394–395.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
18. Timmons MJ, Missotten FE, Poole MD, Davies DM. Complications of radial forearm flap donor sites. Br J Plast Surg. 1986. 39:176–178.
19. Torii S, Namiki Y, Mori R. Reverse-flow island flap: clinical report and venous drainage. Plast Reconstr Surg. 1987. 79:600–609.
20. Urken ML, Biller HF. A new bilobed design for the sensate radial forearm flap to preserve tongue mobility following significant glossectomy. Arch Otolaryngol Head Neck Surg. 1994. 120:26–31.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)