The hand is easily damaged, and impact injuries often affect bones and joints in addition to skin and soft tissue. Thus, choosing an appropriate therapeutic strategy for such injuries is often challenging.
Here, we describe a case in which a hand injury resulted in skin and osteochondral defects, which were reconstructed using a free flap and an osteochondral graft from the same upper extremity.
A 23-year-old male crushed both upper extremities in a serious traffic accident. His right upper limb was minced from the shoulder to hand, and his left hand had a partial skin defect on the ulnar side and an osteochondral defect affecting half of the 5th metacarpal bone head. The right upper limb was too severely damaged to allow it to be salvaged so it was amputated from the shoulder. We therefore focused on saving the left hand. We initially planned to use a pedicle flap from the forearm to repair the skin defect, but the patient did not consent to this strategy. Therefore, we selected a lateral upper arm free flap. The osteochondral defect was reconstructed via capitate osteochondral grafting.
The skin flap and osteochondral reconstruction procedures were both successful, and the patient was satisfied with the outcomes.