Donor-Site Morbidity Analysis of Thenar and Hypothenar Flap

Abstract

Background For the small glabrous skin defect, Thenar and Hypothenar skin are useful donors and they have been used as a free flap. Because of similar skin characteristics, both flaps have same indications. We will conduct comparative study for the donor morbidity of the Free thenar flap and Hypothenar free flap.

Methods From January 2011 to December 2021, demographic data, characteristics of each flap, and complications using retrospective chart review were obtained. Donor outcomes of the patient, who had been followed up for more than 6 months, were measured using photographic analysis and physical examination. General pain was assessed by Numeric Rating Scale (NRS) score, neuropathic pain was assessed by Douleur Neuropathique 4 Questions (DN4) score, scar appearance was assessed by modified Vancouver Scar Scale (mVSS), and patient satisfaction was assessed on a 3-point scale. Statistical analysis was performed on the outcomes.

Results Out of the 39 survey respondents, 17 patients received Free thenar flaps, and 22 patients received Hypothenar free flaps. Thenar group had higher NRS, DN4, and mVSS (p < 0.05). The average scores for the Thenar and Hypothenar groups were 1.35 and 0.27 for NRS, 2.41 and 0.55 for DN4, and 3.12 and 1.59 for mVSS, respectively. Despite the Hypothenar group showing greater satisfaction on the 3-point scale (1.82) compared with the Thenar group (1.47), the difference was not significant (p = 0.085). Linear regression analysis indicated that flap width did not have a notable impact on the outcome measures, and multiple linear regression analysis revealed no significant interaction between flap width and each of the outcome measures.

Conclusion Despite the limited number of participants, higher donor morbidity in general pain, neuropathic pain, and scar formation was noted in the Thenar free flap compared with the Hypothenar free flap. However, no difference in overall patient satisfaction was found between the two groups.

Keywords

free thenar flap - RASP free flap - hypothenar free flap - donor-site morbidity

Authors' Contributions

Conceptualization: D.C.L.

Data curation: H.H.L. and K.J.L.

Formal analysis: H.H.L.

Methodology: J.S.K. and S.Y.R.

Writing - original draft: H.H.L. and S.H.K.

Writing - review & editing: D.C.L.

Ethical Approval

The protocol was approved by our hospital's Ethics Review Board (IRB no. KIRB 2023-N-002), and.

Patient Consent

Informed consent for undergoing procedures was obtained from all patients.

Publication History

Received: 16 April 2023

Accepted: 01 September 2023

Accepted Manuscript online:
06 September 2023

Article published online:
07 February 2024

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