Fig 7A-10. Composite radial forearm flap. A, incisions to be used for thumb reconstruction using a composite radial forearm island flap and neurovascular island flap taken from the ulnar side of the long finger. The radial flap is approximately 7 x 7 cm, and is raised from the distal palmar lateral forearm. B, elevation of the flap together with a segment of the distal radius with careful preservation of radial artery communications between the skin and the bone graft (inset). The artery is ligated proximally, and the flap is tunneled under the first dorsal compartment. The position of the bone graft and the flap are shown. The neurovascular island pedicle flap is raised in preparation for palmar resurfacing of the reconstructed thumb. C, dorsal appearance of the composite radial forearm flap and bone graft in position, showing a small T-plate used for fixation. Note the position of the radial artery. D, completion of the thumb reconstruction, with skin grafts used to cover the radial side of the long finger and the palmar forearm. (Modified from Foucher G, Van Genechten M, Merle M, et al: J Hand Surg 1984; 9B:245; and Strickland JW: Thumb reconstruction, in Green DP (ed): Surgery of the Hand, ed 2. New York, Churchill, Livingstone Inc, 1988. Used by permission.)