Aim:
To present a case of complex hand reconstruction with an osseocutaneous proximal phalanx fillet flap after oncological resection.
Methods:
A 78 year old male guitarist presented with a recurrent Basal Cell Carcinoma (BCC) of the dorsum of his left, non-dominant hand. MRI showed tumor invasion into the 5th metacarpal abuting the periosteum of the middle third of the 4th metacarpal as well as erosion of the extensor tendons of the ring and little fingers and the adjacent dorsal interossei muscles.
Radical resection required resection of the lateral hypothenar muscles, the entire 5th metacarpal, and the 4th metacarpal sparing the distal and proximal joints. The volar neurovascular structures were spared as was the little finger.
A functional ring finger ray was reconstructed using part of the little finger as a pedicled flap to reconstruct the metacarpal and dorsal skin defect.
The little finger was filleted to provide a vascularised osseocutaneous flap including the proximal phalanx. The distal two phalanges were discarded. The articular cartilage of the LF proximal phalanx was trimmed fit the defect and stabilised with 2.0mm plates. The little finger Flexor Digitorum Profundus was harvested for reconstruction of the ring finger EDC tendon.
Results:
The case is presented with a photographic record of the functional
outcome.
Discussion:
Fillet flaps are a useful reconstructive option and commonly used for reconstruction of soft tissue defects in the hand and they are especially useful in cases of multi-digit injury
There is a paucity of literature describing the use of composite osseocutaneous fillet flaps for functional reconstruction of hand defects following oncological resection.
Our case demonstrates the utility of the flap described and reaffirms the principle of spare parts surgery for reconstruction of complex hand defects can contribute to good clinical outcomes without the morbidity of a distant donor site.