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    Thenar Flap

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    Diyar Abdulwahid Salih
    By Dr. Diyar A. Salih, a plastic surgery board trainee. Kurdistan, Sulaimani. It is a powerpoint presentation about reconstruction of finger tip injuries, using thenar flap. It includes definition of the flap, indications, relative contraindications, different designs, marking, operative technique, and complications. I hope you can get benefit from my work.

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    Attribution Non-Commercial (BY-NC)
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    Thenar Flap

    Uploaded by

    Diyar Abdulwahid Salih
    928 views23 pages
    By Dr. Diyar A. Salih, a plastic surgery board trainee. Kurdistan, Sulaimani. It is a powerpoint presentation about reconstruction of finger tip injuries, using thenar flap. It includes definition of the flap, indications, relative contraindications, different designs, marking, operative technique, and complications. I hope you can get benefit from my work.

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    Thenar flap ppt.

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    By Dr. Diyar A. Salih, a plastic surgery board trainee. Kurdistan, Sulaimani. It is a powerpoint presentation about reconstruction of finger tip injuries, using thenar flap. It includes definition of the flap, indications, relative contraindications, different designs, marking, operative technique, and complications. I hope you can get benefit from my work.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPSX, PDF, TXT or read online from Scribd
    Download as ppsx, pdf, or txt
    928 views23 pages

    Thenar Flap

    Uploaded by

    Diyar Abdulwahid Salih
    By Dr. Diyar A. Salih, a plastic surgery board trainee. Kurdistan, Sulaimani. It is a powerpoint presentation about reconstruction of finger tip injuries, using thenar flap. It includes definition of the flap, indications, relative contraindications, different designs, marking, operative technique, and complications. I hope you can get benefit from my work.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPSX, PDF, TXT or read online from Scribd
    Download as ppsx, pdf, or txt
    of 23

    Dr. Diyar A.

    Salih Plastic Surgery Resident Feb 17th, 2013

    Kurdistan, Sulaimani

    Definition
    Flap undersurface

    Recipient defect

    The thenar flap is composed of the palmar glabrous skin and its underlying subcutaneous tissue that is a used for resurfacing fingertip soft tissue defects.

    Indications
    1. Volar pulp injuries (length preservation) 2. Most applicable to index and middle finger 3. Ring and little finger: less often indicated and difficult technically in the small finger. 4. Major distal phalangeal amputations. 5. Amputations of any orientation on the index, long, or ring fingers.

    Relative contraindications
    Preexisting arthritis Joint injury Dupuytren contracture Age is no contraindication (1)

    Age
    Age is not a contraindication Equal success 1-76 years A review of 150 thenar flaps involving all age groups revealed not one incident of joint restriction or other serious complication

    Design
    1. Proximally base:

    a. b.

    venous return high on the thenar eminence MCP skin crease Flap width:
    equal the diameter: simple closure; flat appearance. 1.5 times the diameter: restore the roundness.

    2. 3.

    Distally based H-shaped:


    modifications most commonly used proximal flap cover the defect distal flap undermined in second stage and cover donor defect to eliminate skin graft over thenar eminence.

    Case example

    Volar pulp Exposed bone

    Marking
    Flap designed on the radial aspect of the thenar eminence 1. Reduce PIP joint flexion 2. Place the scar outside the palm Lateral border designed at the thumb MCP joint crease ( protect NVB and flexor pollicis longus)

    Donor site closed primarily or skin grafted

    If flap designed centrally on the thenar eminence: causes painful scar in power gripping

    Modification

    Add fishtail dart if extended to the adductor space distally to prevent contracture.

    Prepping
    Recipient area preparation

    Elevation

    Skin and subcutaneous tissue

    Inset

    Tension-free closure

    Hand positioning
    1. 2. 3. 4. MCP joint (of the recipient finger) fully flexed in a protective position Minimizing PIP joint flexion. DI joint flexion, further improves the position of immobilization Thumb full palmar abduction or opposition

    Dressing

    Advantages
    Recipient: 1. Thicker and more durable than skin graft or cross-finger flap 2. Better color and texture match 3. Highly functional, durable, glabrous skin. 4. Better subjective and objective sensory recovery and cosmesis than did skin graft. 5. Transferring thicker palmar skin (2)

    Recipient 1. Less conspicuous donor scar 2. Avoiding a donor deficit (2)

    Two-stage procedure Finger immobilization in flexion Potential PIP joint stiffness and contracture: Higher in older patients (above 30 years), joint diseases, men with thick, heavy hands, due to prolonged IP joint flexion Limited amount of donor skin Donor site scars: painful, tender, and sensitive (reduced by donor site proper selection) that limiting function of the hand. Donor site skin grafting: tender and sensitive that limiting function of the hand.

    Disadvantages and complications

    Sensory results: good in younger patient and better than with the cross-finger flap. Flap ischemia and necrosis However, in reported series of thenar flap, patients did well with relatively fewer complications.

    Free thenar flap


    based on: Superficial palmar branch of radial artery Palmar cutaneous branch of median nerve. Improved sensory recovery is raised.

    Flap inset After 10 to 14 days (1) The base inset Minimum surgical manipulation to maintain flap viability Active exercises to remobilize the hand

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