Reconstruction of a Volar Thumb Defect Using a Princeps Pollicis Artery Perforator Flap: A Case Report of Partial Flap Congestion and Successful Salvage

Reconstruction of volar thumb defects remains challenging due to the requirement for durable, sensate, and glabrous tissue. Local perforator-based flaps have emerged as reliable options that preserve thumb length and function. We present a case of a 21-year-old female with a volar soft tissue defect over the proximal phalanx of the right thumb following electrical injury. Initial debridement was performed on the first day post-injury, followed by reconstruction using a princeps pollicis artery perforator flap on day 7. The flap measured 2.8 × 2.3 cm and was elevated under brachial plexus block anesthesia. Postoperatively, the patient developed venous congestion between days 3 and 7, which was managed conservatively with limb elevation, partial suture release, and culture-directed antibiotic therapy. The flap subsequently stabilized, with satisfactory healing. At six months’ follow-up, the patient demonstrated full opposition to all fingers, a power grip of 250 N, and key pinch strength of 5 kg, with the ability to perform daily activities. Mild extension lag of 15 degrees and scarring were noted as residual drawbacks. This case highlights the utility of the princeps pollicis artery perforator flap as a single-stage, function-preserving reconstructive option for volar thumb defects, even in the presence of postoperative complications.