Thumb reconstruction with a wrap-around free flap in hand radiation injury

We describe a patient with hand radiation injury that was caused by ¹⁹²Ir radiation source exposure. The cutaneous symptoms that appear after local radiation exposure follow a certain time pattern consisting of the prodromal, manifestation, subacute, chronic, and late stages. Although the clinical characteristics of each stage are well known, limited cases of photographic demonstrations to the progressive local radiation reaction have been reported. We demonstrate characteristics of serial necrotic changes in the fingers after radiation exposure in photographs. Initially, blisters, mild erythema, and swelling were present in the exposed fingers. However, at 3 years postexposure, total necrosis, severe flexion deformity, and bony exposure were present in the exposed fingers. For restoration of hand function, we performed a transmetacarpal, metacarpophalangeal, and transphalangeal amputation of the second, third, and fourth fingers, respectively. After debridement of the necrotic thumb tissue, a wrap-around free flap from the hallux was performed for thumb reconstruction. At 2 years postoperatively, the free flap survived well and graft bone union had occurred. The patient's hand function had improved such that he could grip a large object using the reconstructed thumb and the fifth finger.