Five keypoints in Foucher flap planning and harvesting: Retrospective case series study and literature review

<h2>Abstract</h2><h3>Introduction</h3> The Foucher flap, based on the first dorsal metacarpal artery, is an effective solution for thumb reconstruction following trauma or oncologic resections. This technique allows for the preservation of thumb length and volume while keeping sensitivity and functionality. The success of this surgical approach depends on meticulous planning and execution. This retrospective study analyzes five key aspects related to flap planning and harvesting: defect location, preoperative vascular pedicle identification, flap design, surgical dissection and pedicle insetting. <h3>Patients and Methods</h3> A total of 24 patients who underwent Foucher flap thumb reconstruction between 2013 and 2023 were evaluated. The artery was preoperatively identified using Doppler imaging in all cases. Flap transfer was performed either through subcutaneous tunneling or skin incision, depending on the pedicle's characteristics. Functional and aesthetic outcomes were assessed through the Kapandji score, two-point discrimination and patient satisfaction surveys. <h3>Results</h3> At an average follow-up of six months, all flaps survived entirely. The mean Kapandji score was 8.17 and two-point discrimination in the skin paddle averaged 5.92 mm. Patient satisfaction was high, with 79 % rating their outcome as ``excellent'' and 21 % as ``satisfactory.'' Clinical evaluations confirmed favorable functional and aesthetic results. <h3>Conclusions</h3> The literature review and clinical data support the Foucher flap as a reliable technique for thumb reconstruction. Careful preoperative planning and precise execution are essential to optimizing functional and aesthetic outcomes, minimizing complications and improving patients' quality of life.