Clinical Examples: Thenar Flaps for Fingertip Reconstruction
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The thenar flap is a useful technique for resurfacing fingertip soft
tissue defects. These examples show the following technique of flap design which
allows primary closure of the donor site without dog ears or tension problems: |
| Click on each image for a larger picture |
| Case 1. This patient sustained a pulp amputation which was reattached in the emergency room as a composite graft, nonviable at one week. |
| Flap design is intended to rotate and close the donor defect except for the width of the flap. |
| Flap inset, "bringing the thumb to the finger" with redundant skin in the flap to promote a rounded final tip contour. |
| Result at three months. |
| Donor site. |
| Tip contour. |
| Case 2. A larger defect including the entire distal phalanx pulp, also a failed composite graft of a palmar oblique saw amputation of the fingertip. |
| After debridement: |
| A rhomboid flap is planned to allow primary closure of the distal tip. |
| Inset. |
| Two months postop. |
| Case 3. This thenar flap donor site had been closed with a skin graft by another surgeon. The donor site was tight, and the patient had tenderness and Tinel type paresthesias directly beneath the center of the skin graft, clinically consistent with a neuroma in continuity. Here, a plan for graft excision and Z-plasty closure. |
| The defect was excised, the longitudinal tightness released, and the tender digital nerve was covered. |
| Final result. |
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