Considerations
Length
Sensation on pulp of thumb
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