Palmar Filet Flap for Soft Tissue Reconstruction and Targeted Muscle Reinnervation for Transradial Amputation.

BACKGROUND: Preserving skeletal length in transradial amputation is critical to maintain functional movement and prosthetic fitting. In traumatic or oncologic cases where soft tissue coverage is insufficient, free tissue transfer may be necessary to maximize skeletal length. For patients with segmental disease restricted to the forearm, the hand that would otherwise be discarded can serve as a "spare-parts" free flap. This report describes the use of a palmar filet free flap for coverage and targeted reinnervation in the setting of transradial amputation. METHODS: A 63-year-old woman with multiply recurrent dermal pleomorphic sarcoma of the right forearm underwent transradial amputation for definitive oncologic control. As the hand was not involved by tumor, it was repurposed as a palmar filet free flap to reconstruct the amputation stump without compromising forearm length and achieve targeted muscle reinnervation. RESULTS: The patient underwent successful oncologic resection with negative margins and immediate reconstruction using a palmar free flap. At the 6-month follow-up, she demonstrated protective sensation in the flap without neuroma pain and was successfully fitted with a myoelectric prosthesis. CONCLUSIONS: In select patients, a palmar free flap offers a unique reconstructive option following transradial amputation. This approach provides durable soft tissue coverage without added donor site morbidity, enables sensory restoration through neurotization, and reduces the risk of neuroma-related pain via targeted muscle reinnervation.