Radial fillet flap following double ray amputation of the 2nd and 3rd fingers for invasive squamous cell carcinoma: a case report and review of the literature
Keywords:Case report, Ray amputation, Hand, SCC
Double ray amputation of the hand due to malignancy is extremely rare, with a paucity of published cases. We reviewed the literature and analysed our own experience in order to familiarise clinicians with this rare condition through a discussion of its diagnosis, management and prognosis. We present the case of a 54-year-old male with invasive squamous cell carcinoma (SCC) of the 2nd web space. He underwent a double ray amputation of the 2nd and 3rd fingers with a radial fillet flap and has begun range of motion exercises after six weeks. SCC of the hand requiring a double ray amputation is extremely rare. An MRI is required to accurately diagnose and manage this condition. The ray amputation technique is important for ensuring negative margins. A fillet flap should be used to close the defect as it provides a sensate web-space and improves motor function prognosis.
Askari M, Kakar S, Moran SL. Squamous cell carcinoma of the hand: A 20-year review. J Hand Surg Am. 2013;38(11):2124-33.
Moy RL. Clinical presentation of actinic keratosis and squamous cell carcinoma. J Am Acad Derm. 2000;42(1):3-10.
Puhaindran ME, Athanasian EA. Double ray amputation for tumours of the hand. Clin Orthop Relat Res. 2010;468(11):2976-2929.
CHartier TK, Aasi SZ. Treatment and prognosis of cutaneous squamous cell carcinoma. 2016.
Puhaindran ME, Rohde RS, Chou J, Morris CD, Athanasian EA. Clinical outcomes for patients with soft tissue sarcoma of the hand. Cancer. 2011;117(1):175-9.
Puhaindran ME, Steensma MR, Athanasian EA. Partial hand preservation for large soft tissue sarcomas of the hand. J Hand Surg Am. 2010;35(2):291-5.
Kuntscher MV, Erdmann D, Homann HH, Steinau HU, Scott L, Gunter G. The concept of Fillet flaps: Classification, indications and analysis of their clinical value. J Am Soc Pl Surg. 2001;108(4).
Koegel AM, Banducchi DR, Kahler SH, Huack RM, Manders EK. Sensibility of finger fillet flaps on late follow-up evaluation. J Hand Surg. 1995;20(4):679-82.