The role of the "Eve" procedure in metacarpal reconstruction revised: review of literature and long term results.

INTRODUCTION

The "Eve" procedure is a vascularized composite flap consisting of rib, cartilage, serratus anterior muscle, and fascia. We aimed to re-assess its role in metacarpal reconstruction by means of a literature review and by evaluating the long term outcomes in two cases after a follow-up of more than 30 years. The long term structural stability of the bone and the functional value of the neo-joint were the focus of assessment.

METHODS

A literature review was conducted using PubMed with key terms related to the Eve procedure and metacarpal reconstruction. The two cases published in 1996 were followed more than 30 years later with a clinical and radiological examination.

RESULTS

Since its introduction, the Eve procedure has been reported in 14 patients across various case series. The robust vascularization, muscle coverage for debrided areas, anatomical suitability for metacarpal dimensions, and low rate of donor site complications are amongst its benefits. No other bone flap can offer the same advantages with a safe donor site complications profile. Different joint and metacarpal reconstruction techniques have been elaborated. The clinical scenario usually dictates the possible options for joint reconstruction. In the two original cases, long term follow-up confirmed durable bone integration and preservation of joint space. Imaging showed intact cartilage acting as a joint spacer rather than enabling motion. Functional thumb opposition allowing power grip was achieved through dynamic first webspace reconstruction using the serratus muscle slip. Patient satisfaction with the reconstructed functional hand was high in both cases.

CONCLUSION

The serratus anterior-rib composite flap remains a valuable one-stage reconstructive option in young patients with complex metacarpal defects involving bone and soft tissue loss. Although the vascularized cartilage does not reliably restore joint motion, it contributes to long term structural joint space preservation. Given the low donor site morbidity and positive anatomical, functional, economical and aesthetic outcomes, the Eve procedure still holds clinical value in carefully selected trauma cases.