Reverse Radial Forearm Flap to Provide Arterial Inflow to a Toe Transfer

Background: Toe-to-thumb transfer has become the gold standard for thumb reconstruction, but in badly mutilated hands a suitable recipient artery may not be available and additional soft tissue coverage may be required. There are just a few case reports describing the use of the reverse radial forearm flap for simultaneous coverage of a soft tissue defect around the thumb and provision of a recipient artery for a toe transfer.

Methods: A single surgeon’s experience of all toe-to-thumb transfers into a reverse radial forearm flap between 1995 and 2014 were reviewed. In addition to patient baseline characteristics, the initial injury type, immediate or delayed toe transfer, follow-up period, and complications were analyzed.

Results: Eight toe transfers in 8 patients with an average age of 16.8 years met the inclusion criteria. Four out of 8 patients were children with an age range from 3 to 15 years. Three patients underwent primary toe-to-thumb transfer simultaneously with reverse radial forearm flap reconstruction and 5 patients underwent secondary toe-to-thumb transfer after an initial reverse radial forearm flap reconstruction. There was 1 re-exploration but all toe transfers survived completely. The average follow up period was 5.3 years. All patients were satisfied with the function and appearance of their reconstructed thumb.

Conclusion: The reverse radial forearm flap is a reliable procedure to provide arterial inflow to a toe-to-thumb transfer in difficult situations associated with a lack of a recipient artery and a significant soft tissue defect.