“Kite Flap” for Thumb Reconstruction: A Case Report

Abstract

Thumb injuries, particularly those affecting the distal tip, significantly compromise hand function due to the thumb’s essential role in fine and gross grasp, opposition, and dexterity. Reconstruction of these defects—especially when bone or tendon is exposed—poses a surgical challenge given the limited availability of local soft tissue and the need for durable and sensate coverage. The first dorsal metacarpal artery (FDMA) flap, commonly known as the Kite flap, has emerged as a reliable option for thumb reconstruction due to its consistent vascular anatomy and favorable outcomes. We report the case of a 54-year-old male with a distal thumb injury (Fassler type C) following trauma with an abrasive tool, presenting with a 2 × 1 cm wound and bone exposure. A heterodigital island flap based on the FDMA was elevated from the dorsal aspect of the index finger and transferred to the defect site. The donor site was reconstructed using a full-thickness skin graft. The procedure resulted in complete flap survival, with early mobilization and satisfactory functional and aesthetic outcomes. The Kite flap offers several advantages, including preservation of thumb length, potential sensory recovery, low donor site morbidity, and applicability to both volar and dorsal defects in a single-stage procedure. Despite the potential risk of distal flap necrosis, technical modifications such as avoiding tunneling and including a skin bridge have improved reliability. In conclusion, the Kite flap remains a versatile, effective, and well-established technique for the reconstruction of distal thumb defects, combining structural restoration with functional and sensory rehabilitation.