Bridged Anterolateral Thigh Free Flap for Salvage of a Threatened Distal Digit Following Circumferential Digital Burn: A Case Report

Severe circumferential burns of the finger may result in progressive soft-tissue loss, notwithstanding initial preservation of the distal digit. As circumferential soft-tissue loss progresses, exposed bone, tendon, and neurovascular structures become increasingly vulnerable to secondary necrosis and eventual distal digit loss. We report a 63-year-old woman who sustained a thermal crush burn of the right hand, resulting in progressive circumferential soft-tissue loss at the middle phalanx of the index finger while the distal digit remained clinically viable. Serial debridement was performed as the wound progressively demarcated. At 5 weeks post-injury, a bridged anterolateral thigh free flap was used to provide circumferential vascularized coverage of the index finger and simultaneous coverage of an adjacent middle fingertip defect. While the flap survived completely, distal fingertip perfusion became compromised during the early postoperative period, with focal partial necrosis before gradual recovery. The distal index finger was ultimately preserved without secondary amputation. This case highlights a potential discrepancy between the timing required for safe free flap reconstruction and the narrower window for salvaging a threatened distal digit. Excessive delay while awaiting complete wound demarcation may risk irreversible distal tissue loss in selected circumferential digital burns.