title: Littler's flap revisited: an anatomic study, literature review, and clinical experience in the reconstruction of large thumb-pulp defects.
abstract: BACKGROUND
  An anatomic study and the authors' clinical experience with 15 flaps used for resurfacing sizable thumb defects are presented.
  
  
  METHODS
  Sixteen upper extremities from fresh cadavers were dissected to delineate the anatomy, vascular pattern, and reconstructive potential of the heterodigital island flap. Fifteen heterodigital island flaps were also performed between 1996 and 2004 in 15 patients (mean age: 41.2 years) suffering from a major trauma of the thumb. Flap and donor site skin quality, scar contractures, finger mobility expressed in terms of total active movement, sensibility evaluated by two-point discrimination and the Semmes-Weinstein (SW) monofilament tests, cold intolerance, double-sensibility phenomenon, and cosmetic results were assessed. All patients were reviewed over a postoperative follow-up period of 10-18 months.
  
  
  RESULTS
  Good coverage with well-vascularized skin was obtained and donor-finger full-thickness skin grafting was successful in all cases. All flaps survived completely. Mild cold intolerance was seen in all donor fingers, but no flap had hyperesthesia 10 months postoperatively. Total active range of motion was rated as good or excellent in all patients for both the donor finger and the thumb. Sensation in the donor finger was reported as "slightly altered" and the double-sensibility phenomenon was present in all patients.
  
  
  CONCLUSIONS
  The heterodigital arterialized flap is a single-stage, thin, fairly mobile flap that produces an excellent cosmetic result, restores sensibility, and enables early mobilization of the hand. Morbidity in the donor finger is within acceptable limits and its usefulness in the reconstruction of thumb pulp defects is well documented.
authors.affiliation: Department of Orthopedics, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Greece. drkcxr@yahoo.com
authors.forename: Konstantinos C
authors.initials: KC
authors.lastname: Xarchas
authors.forename: Konstantinos E
authors.initials: KE
authors.lastname: Tilkeridis
authors.forename: Spyridon I
authors.initials: SI
authors.lastname: Pelekas
authors.forename: Konstantinos J
authors.initials: KJ
authors.lastname: Kazakos
authors.forename: Despina D
authors.initials: DD
authors.lastname: Kakagia
authors.forename: Dionysios A
authors.initials: DA
authors.lastname: Verettas
mesh_terms: D000328:Adult; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D013933:Thumb / Q000033:anatomy & histology* / Q000601:surgery*; D055815:Young Adult