Fingertip Reconstruction with the Laterally Based Thenar Flap: Indications and Long-Term Functional Results

Abstract

The thenar flap is a time-tested method of fingertip reconstruction, but functional outcome data are scarce in the literature. The purpose of this study was to analyze the long-term function following fingertip reconstruction with a laterally based thenar flap and to compare these results with other established methods. Nineteen patients underwent a thenar flap between 2001 and 2004. Patients ranged in age from 3 to 48 years. The mean angle of proximal interphalangeal immobilization was 66 degrees (range 30-85 degrees ) and was greater for radial digits. Time to division ranged from 11 to 15 days. Seventeen patients underwent follow-up evaluation of range of motion, two-point discrimination, and sensory threshold (Semmes-Weinstein). A questionnaire measured patient satisfaction in three areas: sensibility, function, and appearance. The mean follow-up was 20 months. Reconstructive goals were met in all cases. The mean metacarpalphalangeal and proximal interphalangeal motion in the reconstructed fingers was not significantly reduced, compared to the unaffected side. The distal interphalangeal motion was 42 degrees , compared to 55 degrees in the contralateral side (p < 0.01). The mean static two-point discrimination in the flap was 6.8 mm, compared to 3.8 mm in the contralateral side. Fourteen of 17 patients exhibited monofilament thresholds of 33.1 g/mm(2) or less. There were no hypertrophic or tender donor scars. This study does not support the contention that thenar flaps are associated with problematic donor scars and flexion contractures, even for adults or ulnar digits. Sensory recovery compared favorably to published results of cross-finger and homodigital flaps. When sound technical principles are followed, excellent outcomes can be expected.

Finger pulp reconstruction with thenar flap: Aesthetic and functional outcome

“…In a study of 150 patients, Melone et al 6 described that modified thenar flap based laterally have shown excellent results. In 2006, Rinker 7 published a study of 19 patients that he used the lateral thenar flap for fingertip reconstruction and reported good functional and aesthetic recovery with minimal complications.…”

Fingertip Reconstruction

“…Rinker evaluated 17 thenar flaps (only 3 in patients over age 45 years) after an average of 20 months. 20 He found no proximal interphalangeal joint contractures in the group but a notable decrease in DIP joint range of motion. Mean static 2-point discrimination was 6.8 mm in the reconstructed fingertips versus 3.8 mm in the uninjured contralateral digits.…”

Extended thenar flap for two adjacent fingertip amputations

“…To obtain adequately sized flaps for both fingertips, we used an ulnar-or radial-based extended thenar flap technique, and the donor site defect was grafted with the skin harvested from the medial aspect of the foot. Melon et al 16 noted that ulnar-or radial-based thenar flaps are used for specific situations, especially loss of exceptionally large pulp portions, and previous studies have focused on the application of radial- 19,20 and ulnar-based thenar flaps 21 in single fingertip amputations. With our technique, we found that wide flap harvest of up to 4-5 cm in length and up to 2.5-3 cm in width could possibly cover the defects of both fingers.…”