- See:
-
Thumb Soft Tissue Defects
-
Amputation of Fingers and Hand
- Indications and Advantages:
- most indicated for amputations distal to thumb IP joint, in which a
V-Y flap cannot be used;
- may cover upto 1.5 cm palmar defect (but not more than 2 cm);
- provides near normal sensibility;
- advancement flaps for lesser fingertip injuries usually will survive if volar flap
incisions are not brought proximally, to the PIP joint;
- in the thumb, the venous drainage is not depended on volar flap, and thus this
technique is safer and the flap can be longer;
- Technique:
- midlateral incision, dorsal to the neurovascular bundles;
- flap is dissected off the flexor tendon sheath;
- flap is advanced of palmar skin of thumb including neurovascular bundles;
- advancement (helped by flexion of IP joint);
- if flap remains under tension, consider proximal transverse incision w/ care
to preserve N/V bundle, w/ subsequent placement of FTSG on secondary defect;
- Disadvantages:
- flexion contractures
- potential for dorsal tip necrosis if neurovascular bundles injured;
- flexion contractures
- potential for dorsal tip necrosis if neurovascular bundles injured;
- advancement flaps for fingertip injuries usually will survive if the volar
flap incisions are not brought proximally, to the PIP joint;
- in the thumb, the venous drainage is not depended on volar flap, and thus this
technique is safer and the flap can be longer;
The Moberg advancement flap for digital reconstruction.
SD Macht and HK Watson.
J. Hand Surg. Vol 5. p 372-376. 1980.
The advancement pedicle flap for thumb injuries.
MA Posner and RJ Smith.
JBJS 53-A. p 1618-1621. 1971.
