Fourteen cases of free thenar flap: a rare indication in digital reconstruction.

BACKGROUND: The thenar area was first used for a free vascularized transfer by Tsai who, in 1991, resurfaced and vascularized a traumatized index finger basing the dissection on the radial digital artery of the thumb. Later, Kamei and Omokawa described a similar flap in finger reconstruction, which was supplied either by the radial artery or its volar branch.

METHODS: Between 1997 and 2005 14 free thenar flaps were performed at Chang Gung Memorial Hospital for thumb (3 cases) and digital reconstruction (11 cases). In 6 cases, the pulp was involved whereas in the remaining 8 cases, the lesion was either in the volar (6 cases) or in the dorsal surface (2 cases) of the fingers. In 7 patients, a perforating branch rising about 3 cm proximal to the wrist crease was the main vascular source of the flap. In 8 cases, the volar radial artery provided adequate blood supply to the flap. No sensory nerve was included in the flap dissection.

RESULTS: Two patients underwent reexploration for arterial thrombosis and venous congestion, respectively, which resulted in complete survival in this series. Donor site morbidity was inconspicuous and, in all cases, the thenar flap provided a well-padded tissue with glabrous skin. In the 7 patients who came back for a final evaluation, 2PD showed poor recover.

CONCLUSION: The free thenar flap offers a thick skin of similar glabrous texture to that of the digits. This flap is especially indicated in those cases of multiple digital injuries or wide skin defects where homodigital or heterodigital island flaps are unsuitable.