title: Fingertip reconstruction with the laterally based thenar flap: indications and long-term functional results.
abstract: The thenar flap is a time-tested method of fingertip reconstruction, but functional outcome data are scarce in the literature. The purpose of this study was to analyze the long-term function following fingertip reconstruction with a laterally based thenar flap and to compare these results with other established methods. Nineteen patients underwent a thenar flap between 2001 and 2004. Patients ranged in age from 3 to 48 years. The mean angle of proximal interphalangeal immobilization was 66 degrees (range 30-85 degrees ) and was greater for radial digits. Time to division ranged from 11 to 15 days. Seventeen patients underwent follow-up evaluation of range of motion, two-point discrimination, and sensory threshold (Semmes-Weinstein). A questionnaire measured patient satisfaction in three areas: sensibility, function, and appearance. The mean follow-up was 20 months. Reconstructive goals were met in all cases. The mean metacarpalphalangeal and proximal interphalangeal motion in the reconstructed fingers was not significantly reduced, compared to the unaffected side. The distal interphalangeal motion was 42 degrees , compared to 55 degrees in the contralateral side (p < 0.01). The mean static two-point discrimination in the flap was 6.8 mm, compared to 3.8 mm in the contralateral side. Fourteen of 17 patients exhibited monofilament thresholds of 33.1 g/mm(2) or less. There were no hypertrophic or tender donor scars. This study does not support the contention that thenar flaps are associated with problematic donor scars and flexion contractures, even for adults or ulnar digits. Sensory recovery compared favorably to published results of cross-finger and homodigital flaps. When sound technical principles are followed, excellent outcomes can be expected.
authors.affiliation: Combined Hand Service, Division of Plastic Surgery, Kentucky Clinic, K454, University of Kentucky, Lexington, KY, 40536-0284, USA. brink2@uky.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: Rinker
references.citation: J Bone Joint Surg Br. 1957 Feb;39-B(1):80-5
references.pmid: 13405949
references.citation: J Hand Ther. 1995 Apr-Jun;8(2):155-62
references.pmid: 7550627
references.citation: Ann Plast Surg. 1996 Aug;37(2):135-9
references.pmid: 8863971
references.citation: J Hand Surg Am. 1982 May;7(3):291-7
references.pmid: 7086099
references.citation: J Hand Surg Am. 1993 Jul;18(4):756-7
references.pmid: 8349996
references.citation: Plast Reconstr Surg. 1984 Feb;73(2):315-9
references.pmid: 6364194
references.citation: J Hand Surg Br. 1989 May;14(2):204-8
references.pmid: 2746121
references.citation: Br J Plast Surg. 1992 Aug-Sep;45(6):443-53
references.pmid: 1393248
references.citation: J Hand Surg Br. 1992 Feb;17(1):102-7
references.pmid: 1640135
references.citation: Plast Reconstr Surg. 2005 Mar;115(3):885-8; discussion 889-90
references.pmid: 15731691
references.citation: Plast Reconstr Surg. 1983 Nov;72(5):698-704
references.pmid: 6622576
references.citation: Plast Reconstr Surg. 1969 Oct;44(4):349-52
references.pmid: 5809004
references.citation: Plast Reconstr Surg. 1967 May;39(5):482-7
references.pmid: 5336916
references.citation: Orthop Clin North Am. 1970 Nov;1(2):219-25
references.pmid: 4940523
references.citation: Plast Reconstr Surg. 1983 Nov;72(5):688-97
references.pmid: 6353456
references.citation: J Hand Surg Br. 2005 Aug;30(4):338-42
references.pmid: 15936132
references.citation: Plast Reconstr Surg. 1965 Apr;35:409-18
references.pmid: 14265365
references.citation: Ann Plast Surg. 2002 Jun;48(6):586-92
references.pmid: 12055426