The “Standing Cone” Flap for Thumb: A Spinoff the Hypogastric Flap in Combined Defects of Dorsum of Hand and Thumb

Background: The management of combined defects of the dorsum of the hand and the thumb can be quite challenging. The conventional teaching has been to use more than 1 flap for such discontinuous defects of the hand. Methods: We present a novel technique to provide a reliable skin cover to a concomitant second defect over thumb, which otherwise would require an additional flap, by recruiting the excess skin available after closure of the primary flap donor site of the hypogastric flap being used for the defect on the dorsum of hand. We report a case series of 5 patients wherein this technique has been used successfully. Results: The modified technique was able to successfully manage the concomitant defects of the dorsum of hand and the thumb in 1 stage. Conclusions: We find this innovation can help cover 2 separate defects on dorsum of hand and the thumb in 1 stage by utilizing just 1 flap instead of the conventional method of raising 2 flaps for such defects.