Reverse thenar perforator flap for volar hand reconstruction

Vascular anatomy of the thenar eminence: its relevance to a pedicled or free thenar flap

“…In contrast to our finding, the literature mentions such connections of SPB to other palmar arteries in 63% of specimens [13]. Because of the always present distal anastomoses the afore mentioned flap could be transferred as a reverse-pedicled, with possible extension towards the LTA field of supply, in order to cover the larger defects of the palm, index finger, and thumb [8,17]. We have found the prominent SPB of the RA in 12 (40%) specimens, with its diameter over 1.70 mm, and dominantly supplying the skin of the thenar eminence, index finger (in all 40% of cases) and the thumb (in 30% of cases).…”

“…Many authors and standard anatomical textbooks have dealt with the vasculature of the hand [3,11,12,15,17]. Only a few articles have been devoted to the cutaneous blood supply of the thenar eminence itself [4,13,16], and there are only scarce data available on the clinical importance of the collateral branches of the radial artery (RA) within the A. Zekavica et al, Arteries of the thenar eminence anatomical snuff-box [7,9,18].…”

“…The conversance of thenar eminence vascularisation is the basis for the design and harvesting the flaps for reconstruction in numerous cases: palmar skin defects, loss of fingertip pulp with tendon and bone, in nerve exposure, or in case of a longstanding scaphoid bone non-union [2,5,17]. Therefore, insufficiency of relevant anatomic data and great surgical significance of this small area call for a study with scientific and practical implications.…”

Reconstruction of volar skin and soft tissue defects of the digits including the pulp: Experience with the free SUPBRA flap

“…15e18 For the medium to large defects, pedicled homodigital 3,6 or heterodigital flaps 19 or pedicled flaps from the palm may be inadequate, limited in reach or compromise the function and cosmesis of the donor digits. 7,13 Delayed donor site wound healing, hypertrophic scars, slower mobilisation of patient and questionable or low patient acceptance commonly complicate the use of the sole of the foot for free tissue transfer. 1,13 Free tissue transfer from the palm is however non-limiting to the patient.…”

“…Glabrous skin can be provided by loco regional flaps, 2,3,6,7 or free flaps from the foot and toes (toe pulp, toe web, medial plantar artery perforator flap using instep skin) 8e13 ), or digits 13,14 and palm. 15e18 For the medium to large defects, pedicled homodigital 3,6 or heterodigital flaps 19 or pedicled flaps from the palm may be inadequate, limited in reach or compromise the function and cosmesis of the donor digits.…”