gms | German Medical Science

Background: The thenar flap, first described by Gateman in 1926, has been extensively used in our unit and we have not observed the many criticisms. The thenar flap is usually indicated in volar oblique defects of the index and middle fingers. The main criticisms are donor site morbidity and joint stiffness. We have analyzed in detail the design and techniques required to achieve a good outcome.

Objectives: By presenting our results and technique, we will dispel the following misconceptions:

The thenar flap results in unacceptable PIPJ stiffness.

The donor site needs to be grafted.

The thenar flap can only be used in the index and middle finger.

Methods: 10 consecutive thenar flap cases were collected over a 6 month period. The demographics, medical history, outcomes, and complications were analyzed. Serial photographs were taken to document intra-operative technique, as well as the final outcome.

Results: All 10 flaps survived completely. All 10 cases regained full range of motion, and none developed a joint contracture. All donor sites were closed primarily without skin graft. All patients were satisfied with the functional outcome and aesthetic appearance.

The following technical refinements are key to achieving a good result:

The thenar flap must be precisely orientated with both the donor site and the final fingertip in mind.

The thenar flap is divided at 3 weeks, but after 2 weeks the flap and finger are exposed and mobilization is encouraged. This softens the flap, makes division easier and prevents joint contracture.

Secondary design depending on arborization during division is necessary to optimize coverage of residual defect.

Conclusion: The thenar flap is a versatile flap that can be used to resurface a variety of fingertip amputations. The refinements above can prevent the complications commonly associated with the thenar flap.