Radial midpalmar island flap

Background: Although defects and contractures of the first web space and the thumb base can be a difficult problem, several local flaps have been used to reconstruct them. However, as most of these flaps are raised from the dorsal aspect of the thumb and the index finger, they may be unsuitable for reconstruction when defects or contractures of the first web space and the thumb base involve the dorsal skin. Methods: In an attempt to resolve this problem, an island flap harvested from die radial aspect of the midpalm and based on the terminal branch of the superficial palmar arch was developed at Chonnam National University Medical School. From 1998 to 2003, this flap was used in 15 patients. The sizes of these flaps ranged from 2 to 3 cm in width and from 2.5 to 5 cm in length. Results: All the flaps survived completely. The donor site was covered with a skin graft in six patients and closed primarily in nine. Healing of most donor sites was uncomplicated. However, in one patient, the skin graft on the donor site did not take completely as a result of subgraft hematomas and a subsequent split-thickness skin graft was required to cover the defect. Conclusions: Although there may be some variations of the vascular pedicle, the radial midpalmar island flap is reliable using careful dissection. This new flap may offer an alternative for reconstructing the first web space and the thumb base in selected patients.