Fourteen Cases of Free Thenar Flap

Sassu, Paolo; Lin, Chih-Hung; Lin, Yu‐Te; Lin, Chih‐Hung

doi:10.1097/sap.0b013e31806ab39f

Cited by 30 publications

(7 citation statements)

References 16 publications

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“…The authors emphasized that the free thenar flap is most appropriate for specific patient cases. This includes individuals with large soft tissue defects that are not suitable for local flaps, patients with multiple digit injuries that are not suitable for cross‐finger flaps, and those who prefer to avoid utilizing soft tissue from the foot (Sassu et al, 2008). Additionally, we argue that the free thenar flap is particularly beneficial for patients whose main motivation is to return to work as soon as possible.…”

Section: Discussionmentioning

confidence: 99%

“…This technique offers a viable solution to meet their occupational goals while achieving successful thumb reconstruction. In our approach, we have built upon the design of the free thenar flap over the thenar eminence, as previously utilized by Sassu et al However, through our evaluation, we have determined that the optimal positioning of the flap involves positioning the flap more ulnarly and placing the ulnar border within the natural crease of the thenar region (Sassu et al, 2008) (Figure 1). Compared to traditional free thenar flap positioning, this positioning offers two distinct advantages (Kamei et al, 1993; Sakai, 2003; Sassu et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

“…In a study conducted by Sassu et al, a series of three thumb pulp defects were effectively reconstructed using the free thenar flap harvested from the thenar eminence (Sassu et al, 2008). The authors emphasized that the free thenar flap is most appropriate for specific patient cases.…”

Section: Case Reportmentioning

confidence: 99%

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The free Thenar flap for thumb pulp reconstruction: A case report

et al. 2023

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The thumb is acknowledged to contribute significantly to hand function, accounting for up to 40% of its overall capability. Consequently, injuries affecting the thumb can have a profound impact on the quality of life experienced by patients. When it comes to the surgical reconstruction of thumb injuries, the primary objective is to promptly provide coverage of the affected area with glabrous skin, thus preserving both the length and functionality of the thumb. Managing injuries specifically involving the thumb pulp can be particularly challenging due to the digit's size and vital role. Acquiring an adequate amount of glabrous soft tissue poses a difficulty in such cases. Various reconstructive approaches, encompassing a range of options on the reconstructive ladder, have been documented for thumb pulp injuries. The most popular options include pedicled flaps and free flaps obtained from both the hands and feet. However, a consensus regarding the optimal method for reconstructing the thumb pulp has yet to be reached. We present a case of total thumb pulp reconstruction for a 40 × 30 mm defect using the free thenar flap in a 65‐year‐old carpenter who sustained a work‐related injury. This flap was designed and raised on the superficial branch of the radial artery with a single subcutaneous vein and a branch of the palmar cutaneous nerve, the flap measured 43 × 32 mm. It was inset transversely with an end‐to‐end arterial anastomosis to the ulnar digital artery, venous anastomosis to the dorsal digital vein and nerve coaptation to the ulnar digital nerve. The postoperative course was uneventful, and the patient was discharged the following day without any complications. Eight months after surgery, the patient was extremely satisfied with the results of the procedure in terms of both function and appearance. The patient had experienced an improvement in function, sensation, and aesthetics. The patient had a QuickDASH disability/symptom score of 15.91 and a QuickDASH work module score of 18.75; the range of motion in the treated thumb was almost the same as the opposite thumb. The patient successfully resumed work three weeks following the procedure, initially with modified duties, and fully regained their work capacity within six weeks. As the patient's primary concern was their ability to return to work, the utilization of a free thenar flap offered several distinct advantages. These included minimal post‐operative complications, facilitated by a single operative site, allowing for reconstruction under regional anesthesia. Moreover, the procedure was conducted in a single stage, enabling the patient to be discharged on the same day without the need for further procedures. Furthermore, similar to several other reconstructive options for the thumb, the utilization of a free thenar flap offered the advantage of providing high‐quality, like‐for‐like glabrous tissue.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The free Thenar flap for thumb pulp reconstruction: A case report

et al. 2023

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“…Volar defects were reconstructed using volar‐side tissues and dorsal defects were reconstructed using dorsal‐side tissues. Venous flaps, thenar free flaps, hypothenar free flaps, and toe pulp free flaps have been used to reconstruct the hand (Chang et al, 2021; Hong et al, 2020; Kim et al, 2013; Kwon et al, 2021; Lee et al, 2008; Lim & Chung, 2020; Lin & Loh, 2019; Pittet et al, 2008; Sassu et al, 2008; Seo et al, 2018; Yang et al, 2010; Zan et al, 2017). However, reconstruction of multiple finger defects should be approached in a totally different way.…”

Section: Discussionmentioning

confidence: 99%

Multiple digit resurfacing with a lateral thoracic free flap: Two‐stage mitten hand and division procedures

Ryoo

Park

et al. 2023

Microsurgery

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PurposeThe conventional abdominal and groin flaps for resurfacing the defect have several disadvantages, including the risk of flap failure due to accidental traction or detachment, immobilization of the arm before division, and aesthetic dissatisfaction because of the flap bulkiness. The aim of this study was to share our experiences with the free lateral thoracic flap and elucidate the optimal timing of division in complex hand reconstruction, which yielded favorable outcomes in terms of both functionality and aesthetics.MethodsThis article is a retrospective review of multiple digit resurfacing using free tissue transfer from 2012 to 2022. Patients who underwent two‐stage operation including mitten hand creation using superthin thoracodorsal artery perforator (TDAp) free flap and secondary division were included. A flap was elevated over the superficial fascia layer the midportion between the anterior border of the latissimus dorsi and pectoralis major muscles and once the pedicle was found, an outline that matched the defect was created. A process named “pushing with pressure and cutting” was carried out before pedicle ligation until all the superficial fat tissue had been removed except for around the perforator. Two cases (18%) involved defects of the entire fingers reconstructed by TDAp flap with anterolateral thigh flap. Six cases (55%) had a super‐thin TDAp flap only. In two cases (18%), non‐vascularized iliac bone grafting was required for finger lengthening. One case (9%) was resurfaced with a TDAp chimeric flap including a skin paddle with the serratus anterior muscle. The primary outcome was defined as the survival or failure of the flap, while the secondary outcomes associated complications such as infection and partial flap necrosis. A statistical analysis was not performed due to the size of the case series.ResultsAll 13 flaps survived completely without any complications. Flap dimension ranged from 12 cm × 7 cm to 30 cm × 15 cm. Mitten hand duration prior to division was 41.9 days on average which was essential for the optimal result. During the division procedures, there were nine cases of debulking (82%), six cases of split‐thickness skin graft (STSG) (55%), and three cases of Z‐plasty performed on the first web space (27%). The mean follow‐up period was 20.2 months. Mean Disability of the Arm, Shoulder, and Hand (DASH) Questionnaire score was 10.76.ConclusionsWe resurfaced severe soft tissue defects of multiple fingers with thin to super‐thin free flaps, mainly TDAp flaps. Surgeons can restore original hand shape using a two‐stage reconstructive strategy of mitten hand creation and proper division timing to create a 3‐dimensional hand structure, even in severely injured hands with multiple soft tissue defects of the digits.

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“…The Free thenar flap can be harvested longitudinally from the thenar eminence towards the scaphoid tubercle in the palm's midline, typically using the superficial palmar branch of the radial artery as the source vessel. [7] The hypothenar free flap can be harvested from within the hypothenar eminence in various sizes and shapes based on the selection of different perforators. [4,8,9] Both flaps are harvested from the palm, allowing primary closure of the donor site and having a limited size available, which emphasizes the need to minimize donor morbidity.…”

Section: Introductionmentioning

confidence: 99%

Donor-Site Morbidity Analysis of Thenar and Hypothenar Flap

Chul Lee,

Hyung Lee,

Hoon Koh

et al. 2023

Arch Plast Surg

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Background For the small glabrous skin defect, thenar and hypothenar skin are useful donor and it has been used as a free flap. Because of similar skin characteristics, both flaps has same indications. We will conduct comparative study for the donor morbidity of the thenar and hypothenar free flap. Methods From January 2011 to December 2021, obtaining demographic data, characteristics of each flap and complications using retrospective chart review. And the patient who had been follow more than 6 month donor outcomes measured using photographic analysis and physical examination. General pain, assessed by Numeric Rating Scale (NRS) score, Neuropathic pain, assessed by DN4 (Douleur Neuropathique 4 Questions) score, Scar appearance, assessed by modified Vancouver Scar Scale (mVSS), and Patient satisfaction, assessed on a 3-point scale. Statistical analysis was performed on the outcomes. Results Out of the 39 survey respondents, 17 patients received Thenar free flaps, and 22 patients received Hypothenar free flaps. Thenar group had higher morbidity of NRS, DN4, and mVSS (p<0.05). Despite the Hypothenar group showing greater satisfaction on the 3-point scale, the difference was not significant (p=0.085). Linear regression analysis indicated that flap width did not have a notable impact on the outcome measures, and multiple linear regression analysis revealed no significant interaction between flap width and each of the outcome measures. Conclusion Higher donor morbidity in general pain, neuropathic pain, and scar formation was noted in the Thenar free flap compared to the Hypothenar free flap. However, no difference in overall patient satisfaction.

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Fourteen Cases of Free Thenar Flap

Abstract: 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.

Cited by 30 publications

References 16 publications

The free Thenar flap for thumb pulp reconstruction: A case report

The free Thenar flap for thumb pulp reconstruction: A case report

Multiple digit resurfacing with a lateral thoracic free flap: Two‐stage mitten hand and division procedures

Donor-Site Morbidity Analysis of Thenar and Hypothenar Flap

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