Simple refinements improve thumb reconstruction post-severe injury

Traumatic thumb injuries remain one of the most challenging issues in hand surgery, especially when traditional reconstructive options are limited.

In a new study published in the Chinese Journal of Plastic and Reconstructive Surgery, a team of researchers from Hue Central Hospital reported promising refinements to a rarely used surgical method — the reverse homodigital dorsoradial flap that could expand reconstructive options for patients with radial thumb defects.

“The case involved a 37-year-old man who sustained a radial-sided thumb injury in a motorcycle accident,” shares lead author Nhat Dang Huy Nguyen, an orthopedic and plastic surgeon at Hue Central Hospital. “Initial treatment failed, leaving exposed bone and tissue loss. As such, our surgeons turned to the reverse homodigital dorsoradial flap, which has a reliable blood supply but with limited adoption.”

Two key refinements made the difference. First, the team preserved approximately 5 mm of subcutaneous tissue to support venous drainage. Second, they left a 3–5 mm buffer zone at the arterial pivot point, identified using handheld Doppler ultrasound, to reduce stress on the delicate blood vessels during rotation.

“The refinements ensured stable blood flow throughout surgery and recovery,” explains Nguyen. “The patient regained nearly normal thumb movement and sensation, returning to work within three months.”

Notably, the flap healed without complications, with the patient’s functional scores improving from significant disability one month post-surgery to near-normal function at one year.

“Sensory recovery was also favorable, with two-point discrimination improving from 5 mm at early follow-up to 4 mm after one year,” adds Nguyen.

The authors encourage future studies to confirm the reliability and reproducibility of the procedure across broader clinical settings.

Contact author details:

MD. Msc., Nhat Dang Huy Nguyen

Center of Orthopedic and Plastic Surgery, Hue Central Hospital, Hue City, Vietnam

Email: nguyendanghuynhat@gmail.com

Conflict of interest:

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

See the article:

Nguyen NDH, Pham HA, Ho PMT, Nguyen PD. Technical refinement of the reverse homodigital dorsoradial flap: A preliminary case report on flap optimization for radial thumb defects. Chin J Plast Reconstr Surg. 2025;7(3):191–196. https://doi.org/10.1016/j.cjprs.2025.08.002