The thenar flap--An analysis of its use in 150 cases.

A skillfully applied thenar flap is an excellent method of restoring major distal soft tissue losses of fingers. It not only provides full-thickness skin of near perfect tissue match but also is the only local flap with sufficient subcutaneous tissues to restore adequately the lost finger pulp. Its recovery of sensibility yields good function, it does not hyperpigment, and the donor site is on the less exposed palmar surface of the hand. Age is not a contraindication for its use. The thenar flap must not be confused with the palmar flap, whose bad reputation is well deserved and whose use if probably never indicated. The cardinal technical principles that must be observed for the thenar flap are (1) design the flap out on the thumb near the MP joint crease, (2) fully flex the MP joint and, when possible, the distal IP joint of the recipient finger to minimize proximal IP joint flexion, and (3) sever the pedicle of the flap after 10 to 14 days and immediately start active exercises. Experience bears out that the thenar flap applied with observance of the stated principles usually offers the best solution for treatment of major distal phalangeal soft tissue losses for all age groups.