Perforator-Based Reverse Radial Forearm Flap to Reconstruct Multiple Third-Degree Burn Defects of the Fingers

Abstract

Adequate soft-tissue coverage is a cornerstone for successful hand reconstruction in burn patients allowing for hand mobilization and rehabilitation. Multiple finger injuries that involve separate soft-tissue defects with complex wounds challenge the reconstruction dilemma. In this case report, a modified application of reverse radial forearm flap for the simultaneous reconstruction of multiple separate finger defects for burn cases is presented. A 23-year-old heavy industry worker is presented with a history of third-degree electrical burn of left index and middle fingers. The proximal interphalangeal (PIP) joint of the both fingers were exposed. A distally based radial forearm flap with a dimension 7.5 x 6 cm was planned. The flap was transposed to the distal defect and splitted. The bilobed flap was inset. A tendon graft is used to span the gap of extensor apparatus before insetting the flaps in both fingers. The donor defect was closed primarily. A satisfactory coverage is observed in the recipient areas. Finger functions including full range of motion of the metacarpophalangeal and PIP joints of the index and PIP and distal interphalangeal joints of long fingers were observed. The technique presented here is advantageous as it is easy to perform, covers multiple finger defects simultaneously, avoids long-term immobilization, saves the operative time, avoids microsurgery. Donor site is closed primarily and finally this approach ensures a simultaneous repair of complex wounds with multiple vital anatomical structures i.e. bone, tendon, joint, and soft tissue.