Long-term outcome of neurovascular palmar advancement flaps for distal thumb injuries.

Thirteen neurovascular palmar flaps for thumb tip coverage were reviewed: six O'Brien and seven Moberg flaps with a mean follow-up of 81 months. Both techniques were found to be safe and effective in preserving pulp sensibility, with a mean 2PD of 5 mm and a Semmes-Weinstein identical to the contralateral side in nine cases. The interphalangeal joint regained a normal range of motion, and did not seem to be affected by the perioperative flexion. The main residual complaints were persistent cold intolerance (present in all cases and severe in three), pulp instability (present in six and severe in two), and nail deformity. This last problem was more related to the injury. Despite these drawbacks, O'Brien and Moberg flaps remain the first choice for coverage of 1-2 cm pulp defects of the thumb.