Reconstruction of the thumb tip using palmar neurovascular flaps

• Published in: Operative Orthopädie und Traumatologie Vol. 24; no. 2; pp. 116 - 121
• Main Authors: Harenberg, P.S., Jakubietz, R.G., Jakubietz, M.G., Schmidt, K., Meffert, R.H.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-04-2012
• Subjects: Anatomy; Hand Surgery; Humans; Medicine; Medicine & Public Health; Operative Techniken; Orthopedics; Plastic Surgery; Reconstructive Surgical Procedures - mortality; Surgical Flaps; Surgical Orthopedics; Thumb - surgery; Traumatic Surgery; Treatment Outcome; Neurovascular flap; Insellappen; Fingerkuppe; Fingertip; Island flap; Neurovaskulärer Lappen; Dehnungslappen; Advancement flap
• ISSN: 0934-6694; 1439-0981
• DOI: 10.1007/s00064-011-0081-3

Objective
Reconstruction of the tip of the thumb using a neurovascular flap.
Indications
Transverse defects of the thumb’s tip or large defects of the palmar pulp (max. 2.0–2.5 cm) with exposure of bone and/or tendons.
Contraindications
Extensive crush injury, heavy wound contamination, circulatory disorders, acute infection, very large defects (> 2.0–2.5 cm finger length), circumferential soft tissue defects, and previous defects/operations (relative).
Surgical technique
Supine position, hand supinated, tourniquet, loupe magnification. Mid-lateral incisions along both sides of the finger running from the defect to the interphalangeal joint (small defect) or proceeding further proximally. Careful elevation of the flap including both neurovascular bundles leaving dorsal branches of the bundles (long fingers only) and the flexor tendon sheath intact. Suture of the flap in either flexion position (i.e., advancement flap) (Moberg) or by creating an island-flap through an additional transverse skin incision along the flap’s base (O’Brien). Finally, closure of the defect at the flap’s base using a full thickness skin graft, Z plasty, or V-Y plasty.
Postoperative management
Plaster cast (finger slightly flexed) for 2 weeks.
Results
Reliable method. Good functional results with good sensibility and only minor reduction in range of motion.