Free vascularized medial plantar flap with functioning abductor hallucis transfer for reconstruction of thenar defects.

We devised a medial plantar flap with a functioning abductor hallucis for simultaneous reconstruction of thenar skin and muscle defects. The anatomy of the flap was studied in five cadaver dissections before surgical attempts were made in patients, who in this series included three men and one woman (average age 38 years, range 26 to 50 years). All patients were followed a minimum of 3 years (average 3 years and 9 months). In all cases, voluntary abduction of the thumb by the transferred abductor hallucis was achieved and confirmed by electromyography. The functioning medial plantar flap provides not only stable skin to the thenar area with sufficient thenar bulk but also satisfactory abduction of the thumb.