title: Thumb salvage with skin grafted medial femoral corticoperiosteal free flap.
abstract: A 23-year-old man suffered a severe crush injury with fracture of his left thumb base phalanx and destruction of his extensor pollicis longus tendon. Immediate plate stabilisation and soft tissue coverage was performed; however, a recalcitrant pseudarthrosis developed in this compliant non-smoker despite three revisions with avascular iliac crest grafts for interphalangeal joint arthrodesis, corticocancellous bone application and hardware exchange. An attempt to improve thumb vascularity and soft tissue cover with a pedicled Foucher flap as well as through extracorporeal shock wave therapy failed. Bone healing and subsequent thumb salvage were finally achieved with a free vascularised medial femoral condyle (MFC) bone flap, which was covered directly with a full-thickness skin graft. Both bony and soft tissue healing went well and after 3 months the patient returned to work. This case demonstrates that skin grafting the periosteal surface of the MFC flap is safe and results in a thin skin-bone compositae transplant which also might be very useful for indications other than hand surgery.
authors.affiliation: Department of Plastic, Hand and Reconstructive Microsurgery, BG Trauma Center Murnau, Professor-Kuentscher-Strasse 8, D-82418 Murnau am Staffelsee, Germany. giesslerplasticsurgery@hotmail.com
authors.forename: Goetz A
authors.initials: GA
authors.lastname: Giessler
authors.forename: Andreas B
authors.initials: AB
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D050278:Finger Phalanges / Q000000981:diagnostic imaging / Q000293:injuries*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D016038:Skin Transplantation; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D013933:Thumb / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed