Foucher Flap to reconstruct volar thumb soft tissue defect surgical technique
Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.
Learn the Foucher Flap to reconstruct volar thumb soft tissue defect surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Foucher Flap to reconstruct volar thumb soft tissue defect surgical procedure.
Thumb contributes to almost half of the hand function. Reconstruction of thumb defects are therefore of a high priority and complex reconstructions are often undertaken to maintain the length and sensations. Pulp of the thumb is a specialised area where the texture of skin and sensations are important. Where possible, local flaps from the thumb tissue is used to reconstruct pulp defects. However when the defects are more substantial, reconstructions become more challenging.
Pulp loss can results from trauma, infection or resection of tumours. Traumatic loss can involve the skin alone, skin and deeper soft tissues or a composite loss involving soft tissues and bone.
There are several reconstructive options for a thumb pulp loss involving the whole of the thumb distal phalanx. These range from skin grafting, cross finger flap from the index finger dorsum, Foucher flap(flap taken from the dorsum of the index finger metacarpal based on the first dorsal metacarpal artery or a free tissue transfer from the great toe pulp based on the dorsalis pedis artery. The reconstructive method is often chosen based on the patient’s functional demands and co-morbidities.
This case illustrates reconstruction of the thumb defect using a Foucher flap. Foucher flap is an eponymous flap based on the first dorsal metacarpal artery and was first described by the French Hand surgeon Guy Foucher.
The radial artery enters the palm between the two heads of the first dorsal interosseus muscle. At this point it gives off a branch called the first dorsal metacarpal artery which divides into smaller branches and supplies a fascia over the first dorsal interosseus muscle and the skin over the dorsum of the index finger. The skin overlying the index finger proximal phalanx can therefore be harvested based on this arterial plexus if the fascia, the overlying superficial radial nerve branches and the superficial veins are harvested. This provides a good quality skin over the thumb which is sensate, though the sensations are referred to the index finger till the brain re-learns it. The donor defect over the index finger will need reconstruction and this is done using a full thickness skin graft taken from a suitable donor site.
Author: Mr Rajive Jose FRCS
Institution: The Queen Elizabeth Hospital, Birmingham, UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.