Reconstruction of the thumb tip using palmar neurovascular flaps.

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.