Advances in Flap Techniques for Thumb and Fingertip Reconstruction

The reconstruction of thumb and fingertip defects has seen significant advancements with the development of more sophisticated flap techniques. These innovations aim to improve the mobility, durability, and sensitivity of the reconstructed area, offering better functional and aesthetic results for patients suffering from trauma.

Key Advancements in Flap Techniques

• The island volar advancement flap for the thumb, a modification of the Moberg method, has proven to be a safe and effective technique. It allows for greater flap mobility by releasing all its attachments except the neurovascular pedicle. This enables coverage of defects up to 3 to 3.5 cm in a single stage, preserving thumb length and providing durable and sensitive skin coverage.

Treatment Options for Finger Reconstruction

The choice of flap technique for fingertip reconstruction depends on the location and nature of the injury:

• Fingertip Injuries:

• Proximal Volar Finger Injuries: Cross-finger flaps (for patients over 30 years old) or axial flag flaps from the middle finger can be used.

• Proximal Dorsal Finger and MCP Injuries: Reverse cross-finger flaps or axial flag flaps from the middle finger are suitable.

• Volar Thumb Injuries:

• Dorsal Thumb Injuries: The dorsal metacarpal artery flap is the technique of choice.

• First Interdigital Space: Z-plasties with 60-degree flaps or the posterior interosseous fasciocutaneous flap can be used.

• Dorsal Hand Injuries: The groin flap is an option for these reconstructions.

Considerations and Complications

Potential complications of these techniques include flap failure due to inadequate arterial flow or insufficient venous drainage. Hook nail deformity can occur due to tight closure of the tip or insufficient bone support. Careful selection of the technique and the surgeon's experience are crucial to minimize these risks and achieve the best possible results.

Sources

• Island volar advancement flap for reconstruction of thumb defects. - Post, Orthobullets.

• Fingertip Amputations & Finger Flaps - Hand, Orthobullets.