The thenar flap provides an excellent tissue match of color, texture, bulk and contour of the lost finger pulp. The free thenar flap offers a thick skin of similar glabrous texture to that of the digits. Here, a plan for graft excision and zplasty closure. Substantial volar defects of the fingers treated with free thenar flaps. This patient sustained a pulp amputation which was reattached in the emergency room as a composite graft, nonviable.
A, flap size was notably larger for patients who underwent radial forearm free flap rfff compared with those who underwent submental island pedicled flap sipf p pdf file. Clinical application of a free radial artery superficial. Palpation of the neck and adjustment of c5 to c7 and t4 vertebrae by the physiotherapist or the orthopedic surgeons. Pdf the radial artery superficial palmar branch flap. Thenar flap for severe finger tip injuries in children f. Innervated and vascularized radial thenar flap free grafting. An example of free flap could be a free toe transfer in which the great toe or the second toe is transferred to the hand to reconstruct a thumb.
The flap was used as a free flap, raised at the level of the metacarpophalangeal joint, and it was used on a woman who sustained a fracture of the middle phalanx and a circumferential laceration of the palmar aspect of the index. For all free flaps, the blood supply is reconstituted using microsurgical techniques to reconnect the artery brings blood into the flap and vein allows blood to flow out of the flap. Flap is attached to finger with interrupted sutures along its lateral margins but tip is left free for optimal restoration of pulp contour. The free tissue transfer is now the best means of reconstructing majorcomposite loss of tissue in the face, jaws, lower limb and many. Jan 18, 2014 ideally, treatment for fingertip injury should involve the least pain possible, using durable and sensate skin with due consideration to aesthetic aspects. A free thenar flap is a fasciocutaneous sensate flap supplied by a constant branch of the superficial radial artery and its variable nerve supply. Extended thenar flap for two adjacent fingertip amputations. Innervated and vascularized radial thenar flap free grafting for partial penile reconstruction after traumatic penile amputation. Donor site morbidity was inconspicuous and, in all cases, the thenar flap provided a wellpadded tissue with glabrous skin. It is a powerpoint presentation about reconstruction of finger tip injuries, using thenar flap. The thenar flap applied skillfully is consistently an excellent method of. The tendon defect was repaired in the palmaris longus tendon.
Free musculofasciocutaneous medial plantar flap for. The aim of this study was to clarify the arterial supply of the skin covering the prominent part of the thenar eminence in order to describe the possibility and potential for harvesting a pedicled or a free flap from the thenar eminence. Donor defect is repaired with fullthickness skin graft taken from wrist. Unlike skin grafts or crossfinger flaps, thenar flaps can provide durable, glabrous skin, as well as sufficient subcutaneous soft tissue to restore the threedimensional structure of the fingertip. The aim of this article was to investigate the clinical application of the radial artery superficial palmar branch flap for softtissue reconstruction of the finger. The crossfinger flap is a popular option under these circumstances fig. A lot of surgical procedures were and are still successfully used, i. Fingertip amputations remain a common problem with many treatment options ranging from simple to complex. These examples show the following technique of flap design which allows primary closure of the donor site without dog ears or tension problems. The thenar flap, described by gatewood in 1926 10, is a reliable and timetested means of composite fingertip reconstruction. To compare and study the functional and aesthetic outcome of finger tip injuries with skin loss which have been managed by thenar flap and cross finger flap. Since its introduction in the literature 30 years ago,v the crossfinger flap has in the experience of many authors jul 12, 2019 splinting of the thumb to immobilize the thumb is an effective way to manage thenar eminence pain.
The crossfinger flap an established reconstructive procedure david a. Submental island pedicled flap vs radial forearm free flap. Kiittikcti departments of plastic and reconstructive surgery and neurology,giilhane militarymedical academy, ankara, turkey summary. This exposed area was covered with a free strip of plaster held on with tape to. The microvascular thenar flap as a new possibility for superthin soft. This thenar flap donor site had been closed with a skin graft by another surgeon. We report the first clinical use of a free microvascular thenar flap for reconstruction of intraoral soft tissues. Wed like to understand how you use our websites in order to improve them. To study the donor site morbidity in the above mentioned patients. Propeller perforator flaps for finger reconstruction. The thenar flap provides an excellent tissue match of color, texture, bulk and. The thenar flap is a useful technique for resurfacing fingertip soft tissue defects. A devascularized index finger with a soft tissue defect on its palmar side was managed by using a small free flap raised at the level of the metacarpophalangeal joint of the thumb. This is distinct from a graft, which does not have an intact blood supply and therefore relies on growth of new blood vessels.
It has a distinct advantage of low donor site morbidity, better cosmesis and texture of the flap. The thenar flapan analysis of its use in 150 cases the thenar flap applied skillfully is consistently an excellent method restoring of major soft tissue losses from the distal phalanx for all groups. Homodigital island flap and small free flaps aim 1. The donor site was tight, and the patient had tenderness and tinel type paresthesias directly beneath the center of the skin graft, clinically consistent with a neuroma in continuity. We treated 125 patients with various finger injuries who underwent free radial artery superficial palmar branch flap reconstruction between october 2010 and march 2015. The microvascular thenar flap is well suited for reconstruction of thin layers. Revascularization of a finger with a thenar mini free flap. A modified free thenar flap with constant innervation article pdf available in journal of reconstructive microsurgery 268. Twelve children aged between 18 months and 11 years old who had sustained a severe fingertip amputation with total or subtotal pulp loss were treated with a distalbased thenar flap. The thenar flapan analysis of its use in 150 cases eaton hand. In the 7 patients who came back for a final evaluation, 2pd showed poor recover. This paper presents two cases of fingertip reconstruction through the use of thenar flaps and nail bed grafts.
The flap was used both as a free flap and as a reverseflow island flap. Mar 12, 2007 a free thenar flap is a fasciocutaneous sensate flap supplied by a constant branch of the superficial radial artery and its variable nerve supply. Fingertip reconstruction with the laterally based thenar flap. The radial digital artery was included in the flap and used to revascularize the index finger, and a palmar vein was used to drain the flap. The extended thenar flap technique is a good alternative for simultaneous. Functional anconeus free flap for thenar reconstruction. Revascularization of a finger with a thenar minifree flap. Free muscle flaps for reconstruction of upper limb defects. Reconstruction of finger composite defects with perforator. The microvascular thenar flap is wellsuited for reconstruction of thin layers. Lateral arm flap pedicle for elbow coverage, free tissue transfer for hand. A free thenar flap a case report journal of orthopaedic. The thenar flap an analysis of its use in 150 cases. B, thenar flap is designed high on thenar eminence near thumb mp joint crease.
The ogo flap is an unipedicled, laterally based flap, transpreservation of length in finger amputations can j plast surg vol 7 no 2 marchapril 1999 61 figure 6a a split thickness skin graft is contoured into place to cover the donor defect figure 6b a lateral view of the graft on the paratenon bed 3 g. We devised a new flap using the palmar cutaneous branch of the superficial radial artery proximally and anastomosed with a cutaneous perforator of the superficial palmar arch distally. A free thenar flap a case report pubmed central pmc. One of the more useful regional flaps is the thenar flap, detailed in this classic article pdf file. Mar 12, 2007 we present a case report of a free thenar flap surgery done for a volar right hand middle finger, distal and middle phalanx degloving injury. Fingertip reconstruction by nail bed grafting using thenar flap.
Flap surgery is a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site with an intact blood supply. Nonsteroidal antiinflammatory drugs nsaids may be prescribed for pain in thenar eminence. Pdf we present a case report of a free thenar flap surgery done for a volar right hand middle finger, distal and middle phalanx degloving injury. Distal and proximalfree supbra flap was elevated together with a 3 cm. Thirtysix patients with volar hand defects 24 digits, 7 palms, and 5 first web space. The mini thenar free flap based on the thumb radial digital artery was presented by tsai et al4 in 1991. May 06, 20 free flaps with fine instruments and materials it has become commonplace to beable to disconnect the blood supply of the flap from its donor site andreconnect it in a distant place using the operating microscope. Flaps for reconstruction of upper limb defects fig. Title a free thenar flap a case report authors garg, r. A free thenar flap a case report article pdf available in journal of orthopaedic surgery and research 21. A free thenar flap a case report journal of orthopaedic surgery. In either case, injury had been due to fingertip crushing and reconstruction was conducted immediately thereafter. The thenar flapan analysis of its use in 150 cases sciencedirect. C, flap is elevated sharply off thenar muscles, taking all its subcutaneous tissues.
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