Reverse Dorsoradial Digital Artery Flap for Reconstruction of Thumb Soft Tissue Defects: A Prospective Clinical Series.

PURPOSE: Soft tissue defects of the thumb exposing tendon or bone require durable, sensate, single-stage coverage. The reverse homodigital dorsoradial digital artery flap is supplied by a constant axial vessel from the radial artery. This prospective case series evaluated its outcomes and identified factors associated with motion, sensory, and scar recovery.

METHODS

Seventeen consecutive patients aged ≥16 years with thumb defects exposing tendon or bone were treated with this flap at a single tertiary referral center between June 2024 and December 2025. Thumb motion was graded with the American Society for Surgery of the Hand criteria, sensation with the American Society of Hand Therapists scale, and scar with the Vancouver Scar Scale at 3 months.

RESULTS

Mean age was 41.3 ± 17.0 years (range, 17-69); 88.2% were men. Defects involved the pulp (47.1%), volar (29.4%), or dorsal (23.5%) aspect; mean flap area was 8.5 ± 2.5 cm2 (range, 4-12 cm2). All flaps survived completely (100%); donor sites were closed primarily in 12 (70.6%) and skin grafted in 5 (29.4%). At 3 months, the American Society for Surgery of the Hand motion was good in 14 patients (82.4%), the American Society of Hand Therapists sensation reached S3 in 12 (70.6%), and the mean Vancouver Scar Scale score was 2.94 ± 1.02. Larger flap area was associated with poorer sensory recovery, and crush/avulsion injuries with higher Vancouver Scar Scale scores.

CONCLUSIONS

The reverse dorsoradial digital artery flap is a safe, reliable, single-stage option for thumb soft tissue defects with high survival, satisfactory motion and sensation, and minimal donor site morbidity. The absence of a control group precludes establishing superiority over alternative reconstructive options.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.