Soft tissue defects

 

 

Considerations

 

Length

Sensation on pulp of thumb

 

Surgical technique paper

 

Local thumb options

 

1.  VY advancement - Atasoy / Kutler

 

 

Indications

 

1 cm defect

 

2.  Moberg advancement Flap

 

 

Indications

 

- cover 2cm² defect

 

Technique

 

Mid-axial incisions from injury site to MCPJ

- entire volar skin flap with both NV bundles

- flex IPJ, suture flap and K wire joint

- can do VY at base, or transverse incision and FTG at base

 

Results

 

Baumeister et al J Hand Surg Am 2002

- pulp thumb reconstruction in 36 cases

- no flap loss

- 74% normal sensation

- some loss of IPJ hyperextension

 

3.  Thumb dorsal ulna flap

 

 

Technique

- island flap on the dorsal island side of the flap

- based on vascular pedicle

 

Flap options

 

1. Kite flap - first dorsal metacarpal artery flap

 

 

Technique

 

Dorsal flap index finger

- proximal phalanx and MCPJ

- based on first dorsal metacarpal artery

- subcutaneous tunnel through to thumb

- skin graft to defect

 

Durgut et al Ann Plast Surg 2022

- 23 patients either Moberg (10) or FDMA (13)

- no statistically signficant difference in return to work, DASH, 2-point discrimination or ROM

- Moberg superior in cold intolerance

 

2.  Partial toe transfer

 

Indications

 

Patient < 40

Can match pulp / bone / nail bed

 

3.  Abdominal Flap