title: Triple chimeric flap based on anterior tibial vessels for reconstruction of severe traumatic injuries of the hand with thumb loss.
abstract: BACKGROUND
  Reconstruction of severe traumatic injuries of the hand with digit loss may require multiple procedures over a prolonged period. The authors present a clinical series of patients in which these types of injuries were reconstructed in a single operation.
  
  
  METHODS
  A chimeric flap based on the anterior tibial vessels is described. A total of three free tissue transfers included an anterior tibial flap, a dorsalis pedis flap, and a great toe wrap-around flap. These triple flaps were transferred to resurface the defects of the mutilated hand, which was involved in the thumb, first web space, volar palm, thenar eminence, or radial aspect of wrist. The cumulative size of the defects ranged from 9 x 11 cm to 12 x 18 cm.
  
  
  RESULTS
  From 2002 to 2007, six patients with multiple defects of the hand and thumb underwent reconstruction using the described technique. The donor sites were covered by means of split-thickness skin grafting. All flaps survived and patients were satisfied with the functional and aesthetic outcome postoperatively at 6 to 12 months' follow-up. The average improvement of thumb opposition was 4.8 on the Kapandji scale. Sensory recovery of the thumb tip of S3 was achieved. There were no major donor-site complications.
  
  
  CONCLUSIONS
  A chimeric flap based on the anterior tibial vessels is an excellent method of reconstruction of severe multilevel injuries of the hand, including thumb loss.
authors.affiliation: Shanghai, China; and Durham, N.C. From the Division of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, and the Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Medical Center.
authors.forename: Yi Xin
authors.initials: YX
authors.lastname: Zhang
authors.forename: Danru
authors.initials: D
authors.lastname: Wang
authors.forename: Yuguang
authors.initials: Y
authors.lastname: Zhang
authors.forename: Yee Siang
authors.initials: YS
authors.lastname: Ong
authors.forename: Keith E
authors.initials: KE
authors.lastname: Follmar
authors.forename: Amir H
authors.initials: AH
authors.lastname: Tahernia
authors.forename: Fong Kung
authors.initials: FK
authors.lastname: Pang
authors.forename: Detlev
authors.initials: D
authors.lastname: Erdmann
authors.forename: Yunliang
authors.initials: Y
authors.lastname: Qian
authors.forename: L Scott
authors.initials: LS
authors.lastname: Levin
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D001808:Blood Vessels / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery*; D018482:Muscle, Skeletal / Q000637:transplantation*; D013524:Surgical Flaps; D013933:Thumb / Q000293:injuries* / Q000601:surgery*; D013977:Tibia / Q000098:blood supply*