[Use of reverse flow pedicled osteo-fascio-cutaneous radial forearm flap in reconstruction of the first ray in the hand].

A reverse flow pedicled osteo-fascio-cutanous radial forearm flap was applied in different clinical situations. Treatment of 1 female patient--age 28 years, and 3 male patient--age 17, 29 and 33 years is presented. Indications for treatment were: congenital malformation of the thenar region and thumb, deficit of the soft tissue, of the IMP joint and a segment of the first metacarpal bone, amputation of the thumb at IMP level and congenital total absence of the first ray of the hand. The author's modification of total thumb reconstruction is presented. Some steps of the procedure, using osteo-fascio-cutaneous radial flap differed from the original Biemer and Stock method. Donor site was located on the medial and radial part of the forearm. The flap was planned, elevated longitudinally and folded over the vascularized radial bone graft. In thumb reconstruction cases no implants were used for bone fixation. Part of the radius was directly nailed into the distal part of the first metacarpal. Bone healing was observed after 6 weeks and its remodeling took nearly 6 months. There were no complications at the donor site (one was closed directly and two by skin grafts). Two flaps were remodeled because of soft tissue abundance. Functional and cosmetic results were good in all four cases.