LAUSR

An extensive traumatic volar defect of the thumb may result in obvious morbidity which requires major efforts to salvage. The goal of thumb reconstruction is to restore function, as well as to provide the hand with an acceptable appearance with minimal donor-site morbidity. The choice of thumb reconstruction depends on the amount and location of tissue lost. The option varies from healing by secondary intention, skin grafts, and vascularized tissue transfer. Here, we present a 55-year-old man with left thumb injured from the electric saw. There was a 3 × 2 cm sized soft tissue defect with bone exposure over the ulnar site of the thumb (Figure 1A). The pedicled first dorsal metacarpal artery (FDMA) flap was indicated and transferred to cover the defect. However, the flap presented with poor perfusion. We immediately prepared the branch of the radial artery and cephalic vein as the recipient vessels and utilized the anterolateral thigh (ALT) flap to cover the defects over the thumb and index. The harvest of the ALT flap was done as usual fashion. After identifying the perforators arising from the descending branch of lateral circumflex femoral artery (LCFA), we prepared the skin paddle to cover the FDMA flap donor site. Under tedious pedicle dissection, we also prepared quite enough length of the vascular pedicle of the descending branch of the LCFA and inset into the thumb defect (Figure 1B). The patient was thin, and we did not thin his ALT flap before flap inset. To monitor distal stump of the vascular pedicle from the ALT flap that went into the thumb defect, we just applied wet cotton gauze to maintain moisture without skin grafting. The postoperative recovery was uneventful with complete survival of the flap. The patient was discharged 4 days after surgery. Ten days after operation, the thumb defect was fully restored with granulation tissue. The wound was re-epithelialized within 4 weeks. The patient was able to perform full thumb opposition with no contracture of the first web space (Figure 1C). The total duration of follow-up was 3 months. Since its first description by Song, Chen, and Song (1984), the ALT flap has been evolved as one of the most versatile perforator flaps. To the best of our knowledge, utilization of the distal stump of the vascular pedicle of the ALT flap has been rarely described in the literature. For monitoring the buried ALT flap in hypopharyngeal reconstruction, Spyropoulou, Kuo, Chien, Yang, and Jeng (2009) left the distal stump of the LCFA on the skin surface and covered with dressing. The postoperative flap monitoring was performed by direct observation of the pulsation of the stump. In our case, the thumb