title: Thinned chimeric radial collateral artery perforator flap in complex distal thumb reconstruction.
abstract: BACKGROUND
  Tissue loss accompanied by bone defects in the thumb is a challenging reconstruction problem. Traditional repair methods are unsatisfactory.
  
  
  METHODS
  Microsurgical thumb reconstruction was performed using 13 thinned chimeric radial collateral artery (RCA) perforator flaps. The flap was created with a thinned skin paddle and humeral bone segments using independent perforators. Primary defatting was completed when the thickness of the perforator entry was approximately similar to that in the periphery. The posterior cutaneous nerve of the arm was carried to make a sensory flap. Defects were 8.5 × 4.5 cm(2) on average (ranging in size from 4.5 × 1.5 to 15.0 × 6.0 cm(2)), and flap size was 9.0 × 5.5 cm(2) on average (ranging in size from 5.0 × 2.0 to 16.0 × 7.0 cm(2)), whereas the humeral fragments were 2.0 × 1.0 cm(2) on average (ranging in size from 1.5 × 0.5 to 4.0 × 1.5 cm(2)). All data were expressed as mean ± SD. The cosmetic appearance of the donor and recipient sites, Kapandji opposition score and static two-point discrimination of the operated thumb were evaluated during a follow-up visit.
  
  
  RESULTS
  Follow-up time was 16.6 months (ranging from 14 to 28 months). Flap thickness before defatting, measured immediately after flap elevation was 14.5 mm (ranging from 10.0 to 25.0 mm). Average flap thickness after defatting was 3.5 mm (ranging from 3.0 to 6.0 mm). Venous congestion occurred in two cases. Successful microsurgical revision was achieved in both cases. All flaps survived. Bone components achieved union in all cases at an average period of 4.8 months (ranging from 3 to 6 months). Based on Kapandji opposition score, the mean thumb opposition score was 6. The mean sensation of flap was 7.5 mm (ranging from 6 to 11 mm). No further flap revision or defatting procedures were required in all cases. Cosmetically acceptable results were achieved for all patients.
  
  
  CONCLUSIONS
  Findings proved that thinned chimeric RCA perforator flap is a beneficial microsurgical alternative for reconstructing complex bone and soft tissue defects in thumb.
authors.affiliation: Department of Head and Neck Surgery, Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China.|Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Dajiang
authors.initials: D
authors.lastname: Song
authors.affiliation: Hand Surgical Centre, Nanhua Hospital, Nanhua University, Henyang, China.
authors.forename: Xiangwu
authors.initials: X
authors.lastname: Deng
authors.affiliation: Hand Surgical Centre, Nanhua Hospital, Nanhua University, Henyang, China.
authors.forename: Yanmin
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Hand Surgical Centre, Nanhua Hospital, Nanhua University, Henyang, China. xiesonglinpro@163.com.|Department of Orthopaedics, Xiangya Hospital of Central South University, Changsha, China. xiesonglinpro@163.com.
authors.forename: Songlin
authors.identifier: http://orcid.org/0000-0001-5632-4854
authors.initials: S
authors.lastname: Xie
authors.affiliation: Department of Head and Neck Surgery, Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China. zhouxiaopro@163.com.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003097:Collateral Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013933:Thumb / Q000098:blood supply / Q000601:surgery; D055815:Young Adult
keywords: Chimeric flap; Composite defect thumb; Lateral arm flap; Radial collateral artery