Refinements in the design and division of the thenar flap to achieve better functional results

Though the thenar flap has been described since 1926, its use has not been widespread. The main criticisms are donor site morbidity and proximal interphalangeal joint (PIPJ) stiffness. In this paper, we describe a standard design technique for flap design and division to address these two issues. From July 2018 to April 2019, a total of ten patients underwent thenar flap reconstruction of the fingertip. The flap dimensions ranged from 10 mm x 10 mm to 25 mm x 15 mm. All the flaps survived. One patient developed wound infection post division. All donor sites were closed primarily without skin graft. We are using mirror image technique to elevate the flap to ensure that it is inset in the position as we planned without displacement. It largely reduced the chance of rotation and extensive tension when fix the finger to the thenar region. Our technique allows for the flap design to be individually customized based on the orientation of the defect, making it simpler and more replicable. We have also emphasized how care during division of the thenar flap can help prevent complications. (c) 2021 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)