The Proximal Inset Thenar Flap for Fingertip Reconstruction

Dellon, A. Lee; Beasley, Robert W.

doi:10.1097/00006534-198311000-00023

Cited by 13 publications

(15 citation statements)

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“…The static 2-PD in our patients ranged 4–10 mm with mean (6.33 ± 2.21) mm while dynamic2-PD had ranged 2–8 mm with mean (4.41 ± 1.70) mm, which is comparable with a report by Dellon 9 in a series of 5 patients where static 2-PD was 5.6 mm and dynamic 2-PD was 3.3 mm. Similarly, in a study of Barbato et al 10 reported static 2-PD was 6.5 mm in their series of 20 patients.…”

Section: Discussionsupporting

confidence: 90%

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Finger pulp reconstruction with thenar flap: Aesthetic and functional outcome

Sahu

Kala

Dixit

et al. 2020

Chinese Journal of Traumatology

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Purpose Fingertip injuries are common in industrial production activities as well as in domestic work. Loss of pulp hampers daily life activities. Functional and aesthetic aspects are important in fingertip reconstruction. The bone is usually exposed along with soft tissue loss. Therefore to reconstruct the pulp flap with adequate bulk is required. Methods We reported a case series of 12 patients with the injury over the volar aspect of distal phalanx of the index or middle finger. In all cases, laterally based thenar flap was chosen. The flap donor site was closed primarily in most of cases, while 4 patients required skin graft. The flap was detached between 2–3 weeks. Functional assessment was done using static and dynamic 2-point discrimination and range of motion at each joint. The aesthetic outcome was assessed through questionnaire. The results were analyzed using the unpaired t -test (SPSS version 21). Results Partial necrosis occurred in 2 cases while rest of flaps survived successfully. Static 2-point discrimination ranged from 6–10 mm, mean 8.6 mm; and dynamic 2-point discrimination ranged from 8–10 mm, mean 8.9 mm. The mean satisfaction score was (4.0 ± 0.55). Conclusion Thenar flap is a good choice for reconstruction of the finger pulp as it provides the bulk with good functional and aesthetic outcome.

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Section: Discussionsupporting

confidence: 90%

“…The functional outcome of flap after detachment was assessed by static 2-PD and dynamic 2-PD along with the range of motion at each joints of the operated finger. Dellon 9 reported static and dynamic 2-PD as 5.6 mm and 3.3 mm respectively in a series of 5 patients. The p values of above-mentioned results were 0.758 and 0.427, respectively.…”

Section: Discussionmentioning

confidence: 95%

Finger pulp reconstruction with thenar flap: Aesthetic and functional outcome

Sahu

Kala

Dixit

et al. 2020

Chinese Journal of Traumatology

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“…Since the vascularity of the thenar area is considerably rich from the underlying fascia and muscles, there are several reports of the thenar flap with an extended design. Dellon 23 modified the thenar flap to resurface a larger area of skin and softtissue defect of the finger, and had good clinical results. Although this extended flap could cover a considerably large palmar defect of the digit, this is a two-staged procedure and may cause a joint contracture of the finger.…”

Section: Discussionmentioning

confidence: 99%

Reverse-Flow Island Flap from the Thenar Area of the Hand

Omokawa

Takaoka²,

Shigematsu³

et al. 2002

J reconstr Microsurg

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A reverse-flow island flap from the thenar eminence of the hand was applied in six patients to treat palmar skin defects, and amputation injuries of the thumb. There was one female and five males, and the patients' ages at the time of surgery averaged 48 years. A 3 x 2 to 5 x 3.5-cm fasciocutaneous flap from the radial aspect of the thenar eminence, located over the abductor pollicis brevis muscle, was designed and transferred in a retrograde fashion, to cover skin and soft-tissue defects of the thumb. The flap was based on the superficial palmar branch of the radial artery and, in three patients, was made sensate by the palmar branch of the superficial radial nerve. Follow-up periods averaged 61 months. The postoperative course was uneventful, and all the flaps survived without significant complications. The donor site was primarily closed in five patients, and one patient required flap coverage. A reverse island flap from the thenar area is easily elevated, contains durable fasciocutaneous structures, and has good color and texture, matching to the finger pulp. This flap offers a good alternative for reconstruction of palmar skin and soft-tissue defects of the thumb in selected patients.

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“…Other local flaps include the Ogo (7) and Flint/Harrison (8) flaps, which use the dorsal skin of the finger for coverage. The Ogo flap is an unipedicled, laterally based flap, trans- Cross-finger flaps (9) and thenar flaps (10,11) have worked well for coverage, but, again, are not sensate and may interfere with the function of the other fingers or hand because of stiffness or pain. Modifications to the cross-finger flap have incorporated dorsal digital nerves, which are subsequently anastomosed with the volar nerves to achieve a sensate flap (12).…”

Section: Discussionmentioning

confidence: 99%

The visor flap: Preservation of length in finger amputations

Neumeister¹,

Robertson²

1999

CAN J PLAST SURG

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M ethods of closure of the amputated finger stump are legion. Certain levels of amputation, however, demand preservation of length for optimum function. The visor flap provides this, together with sensation, padding and scars that avoid volar pressure points. The design of the flap follows the principles of three-dimensional rather than plane geomery. PRINCIPLES OF FLAP DESIGN The visor flap is a bipedicled flap based on the dorsal branches of the volar digital neurovascular bundles (Figure 1). Transverse amputations of the distal, middle and distal proximal phalanges are most suitable for this technique. Figure 2 illustrates the design of the dorsal flap. The volar/dorsal diameter of the amputation site is measured (A-B). To achieve adequate coverage, a similar area of dorsal skin and subcuta-neous tissue must be obtained (A-C), therefore, A-B is equal to A-C. The extent of the lateral incisions are to the mid axial line (D). The pivot point, D, restricts the volar transposition of this bipedicled flap because C-D is shorter than A-C. Therefore, a back cut (Figure 3) is made so that AD 1 is equal to C-D 1. The new pivot point of D 1 allows adequate volar transposition of the flap. The back cut must be through dermis only to avoid potential damage to the neurovascular structures in the subcutaneous plane. The dissection is deepened down to but not through the paratenon level. The flap is undermined and transposed distally, and sutured with a nonabsorbable suture. The donor defect is covered with a split thickness skin graft and dressed appropriately: excess skin (dog ears) may be prominent laterally, but these should not be tailored because this may interfere with the neurovascular supply to the flap. Physiotherapy to maintain range of motion is initiated on postoperative day 7. Skin graft maturation and contraction aids in the resolution of the dog ears and acts as a force in drawing the volar scar dorsally, leaving a volar surface free of a potentially prominent and/or painful scar line.

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The Proximal Inset Thenar Flap for Fingertip Reconstruction

Cited by 13 publications

References 0 publications

Finger pulp reconstruction with thenar flap: Aesthetic and functional outcome

Finger pulp reconstruction with thenar flap: Aesthetic and functional outcome

Reverse-Flow Island Flap from the Thenar Area of the Hand

The visor flap: Preservation of length in finger amputations

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