Cadaveric Study of a Z-Plasty Modification to the Moberg Flap for Increased Advancement and Decreased Morbidity

Abstract

Although the O'Brien modification allows approximately 50 percent further advancement than the Z-plasty modification compared with the standard Moberg flaps, the increase correlates to a large area of exposed neurovascular bundles at the volar base of the thumb, which requires secondary coverage. However, all Z-plasty donor-sites could be closed primarily. Primary closure of all donor sites will decrease healing time, wound complications, digital nerve sensitivity, and cosmetic appearance. This study is the first to show a significant increase in Moberg flap advancement using Z-plasty lengthening at the thumb base while avoiding any increased morbidity.

V-Y Flap Over Moberg’s Flap to Cover the Thumb’s Fingertip Injury: Technique and Cases

“…Neurovascular bundles are dissected, protected and the flap is advanced, and the secondary defect closed with a skin graft 6 . This latter modification allows an average of 7,7 mm more advancement of the flap 13 …”

“…6 This latter modification allows an average of 7,7 mm more advancement of the flap. 13 A modification using a V-Y proximal flap over the Moberg's flap has been previously described by Elliot et al 17 In this modification, a V-Y flap is used proximally to achieve closure of the defect at the base of thumb. Shah et al 18 have made a similar V-Y flap modification proximally to achieve greater advancement.…”

“…These incisions are made from the flexion crease of the metacarpophalangeal joint to the tip. All the palmar pad is raised, in the plane immediately superficial to the sheath of the flexor mechanism; neurovascular bundles should be protected during dissection 1,13–15 …”

“…All the palmar pad is raised, in the plane immediately superficial to the sheath of the flexor mechanism; neurovascular bundles should be protected during dissection. 1,[13][14][15] Some modifications have been made to aid in distal or proximal coverage…”

Comparison of the Modified Moberg Flap Versus First Dorsal Metacarpal Artery Flap for Thumb Pulp Reconstruction

“…The Moberg flap is considered to be a standard option for the thumb with medium-sized defects of <2 cm in length. 13,18,19 By modifying the Moberg flap, it can be used for larger defects. Although the FDMA flap is normally used for larger defects, we applied these methods to the same type of defects to ensure standardization in the study.…”