Triangular Vascularized Free Fibula Flap for Massive Carpal Reconstruction

Massive carpal loss following trauma, tumor, or infection poses a difficult reconstructive challenge. There are limited reconstructive options for such cases, particularly when the metacarpal bases are also lost. We describe a method of carpal reconstruction using closing wedge osteotomies in a triangular vascularized free fibular flap, and a proposed algorithm for the management of metacarpal instability in this setting.