Reconstruction Using Pedicled Inguinal Flap Type Mc Gregor in the Right Hand First Digit, Secondary to Necrosis Due to Loxosceles Spider Bite: Case Report

Abstract

Loxosceles spider bite represents a relevant health problem in endemic regions, mainly due to its cutaneous manifestations characterized by progressive necrosis that is difficult to manage. We present the case of a 13-year-old female patient who arrived at our center with necrosis of the volar pulp of the right thumb, secondary to Loxosceles spider bite, showing rapid progression to ischemia and necrotic eschar despite initial management with specific antivenom, antihistamines, corticosteroids, and antibiotic therapy. In the absence of dermal matrices or other microsurgical resources, it was decided to perform reconstruction using a pedicled inguinal flap type McGregor, a classical technique described by McGregor and Morgan in 1972, based on the vascular axis of the superficial circumflex iliac artery. Surgical lavage, debridement of devitalized tissue, and subsequent rotation of the flap were performed, ensuring proper defect coverage and fixation. The postoperative course was uneventful, with flap division at 21 days and favorable clinical follow-up, preserving both function and aesthetic appearance of the thumb. This case highlights the validity and usefulness of the McGregor flap as a reconstructive alternative in complex hand injuries, even in less conventional etiologies such as cutaneous loxoscelism, underscoring its applicability in resource-limited settings. The evidence obtained reinforces the need to consider classical reconstructive techniques as part of the current surgical arsenal, while also promoting systematic documentation of these cases to enrich the existing literature.