Thumb reconstruction using the radial midpalmar (perforator-based) island flap (distal thenar perforator-based island flap)

Kwang Seog Kim, Eui Sik Kim, Jae Ha Hwang, Sam Yong Lee
Plastic and Reconstructive Surgery 2010, 125 (2): 601-8

BACKGROUND: Although the reconstruction of palmar defects of the thumb with exposed vital structures is difficult because of a lack of locally available tissue, several local flaps are available for the reconstruction of these defects. The majority of these flaps are raised from the dorsal or dorsolateral aspect of the thumb and index finger or from the forearm.

METHODS: Between 1998 and 2008, 23 patients underwent reconstruction of palmar defects of the thumb at Chonnam National University Medical School, using the radial midpalmar (perforator-based) island flap (distal thenar perforator-based island flap), a perforator-based island flap harvested from the radial aspect of the midpalm and based on perforators from the terminal branch of the superficial palmar arch and the princeps pollicis artery.

RESULTS: All flaps survived completely. Flap sizes ranged from 2 to 4 cm in width and from 2.5 to 6 cm in length. Donor sites were closed primarily in 10 patients and covered with skin grafts in 13 patients. Healing of all donor sites was uncomplicated, and donor-site morbidity was minimal with acceptable scarring. Long-term follow-up ranging from 6 to 37 months (mean, 16 months) revealed excellent flap sensibility.

CONCLUSIONS: The radial midpalmar (perforator-based) island flap offers acceptable functional and cosmetic outcomes with respect to elasticity, durability, skin color and texture, and sensation for the reconstruction of extensive palmar defects of the thumb. The authors recommend that this flap be considered a treatment of choice for the reconstruction of these defects.

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