Innervated Thenar Pedicle Flap with the Palmar Cutaneous Branch of the Median Nerve for Treating a Thumb Pulp Defect: A Case Report

Abstract

A 51-year-old male plumber with a thumb pulp defect was treated with a reversed innervated thenar pedicle flap. The flap was based on the radial digital artery originating from the princeps pollicis artery with the palmar cutaneous branch of the median nerve. The flap survived and achieved good innervation with a moving 2-point discrimination of 6 mm at 12 months after surgery. This flap is indicated for patients who hesitate to have tissue taken from the foot. We believe that this flap is a feasible option for reconstructing thumb pulp defects.

Keywords

thenar flap - innervated - palmar cutaneous branch

• References

• 1 Lee WP, Salyapongse N. Thumb reconstruction. In: Green DP, , ed. Operative Hand Surgery, 5th ed. New York, NY: Churchill Livingstone; 2005: 1865-1911
• 2 Woon CY, Lee JY, Teoh LC. Resurfacing hemipulp losses of the thumb: the cross finger flap revisited: indications, technical refinements, outcomes, and long-term neurosensory recovery. Ann Plast Surg 2008; 61 (4) 385-391
• 3 Oka Y. Sensory function of the neurovascular island flap in thumb reconstruction: comparison of original and modified procedures. J Hand Surg Am 2000; 25 (4) 637-643
• 4 Minami A, Usui M, Katoh H, Ishii S. Thumb reconstruction by free sensory flaps from the foot using microsurgical techniques. J Hand Surg [Br] 1984; 9 (3) 239-244
• 5 Kato H, Ogino T, Minami A, Usui M. Restoration of sensibility in fingers repaired with free sensory flaps from the toe. J Hand Surg Am 1989; 14 (1) 49-54
• 6 Melone Jr CP, Beasley RW, Carstens Jr JH. The thenar flap—An analysis of its use in 150 cases. J Hand Surg Am 1982; 7 (3) 291-297
• 7 Matsuura S, Kojima T, Kinoshita Y, Endo T. Reverse vascular pedicle thenar island flap. J Jpn P R S 1990; 10: 491-496 (in Japanese)
• 8 Omokawa S, Takaoka T, Shigematsu K , et al. Reverse-flow island flap from the thenar area of the hand. J Reconstr Microsurg 2002; 18 (8) 659-664
• 9 Yang JW, Kim JS, Lee DC , et al. The radial artery superficial palmar branch flap: a modified free thenar flap with constant innervation. J Reconstr Microsurg 2010; 26 (8) 529-538
• 10 Sakai S. Free flap from the flexor aspect of the wrist for resurfacing defects of the hand and fingers. Plast Reconstr Surg 2003; 111 (4) 1412-1420 , discussion 1421–1422