Thumb reconstruction using a free osseocutaneous fibular flap following excision of an epithelioid haemangioendothelioma

Epithelioid haemangioendothelioma are a rare type of aggressive vascular tumour, which can occur in multiple areas of the body. Current treatment is surgical with wide excision of the tumour and surrounding tissue often resultant in large defects requiring reconstruction. We present the case of a patient with an epithelioid haemangioendothelioma affecting the proximal and distal phalanx of their dominant thumb. Local reconstructive options were poor given the wide excision margin including both skin and bone. After careful consideration, the decision was made to reconstruct the area using a free osseocutaneous fibula flap to provide both vascularised bone and an overlying skin paddle. We report the first documented case of a thumb reconstruction with an osseocutaneous free fibula flap following excision of an epithelioid haemangioendothelioma.

Level of Evidence: Level V, therapeutic study.