Arterialized Venous Free Flaps Using the Thenar Region for Reconstruction of Finger Pulp Defects

Various methods have been introduced to reconstruct finger pulp defects. A region which has a similar skin texture to the pulp is suitable as a donor site. Arterialized venous free flaps are usually used for the reconstruction of the soft tissue of fingers, because of their thinness. The thenar and hypothenar regions have similar skin texture to the finger pulp. There have been reports in which the recovery of sensibility is good without nerve anastomosis, when the thenar and hypothenar regions are used as donor sites. But using the hypothenar region is more difficult, because the vessels are smaller than in the thenar region.

These authors have had experience with 17 cases of arterialized venous free flaps using the thenar region to reconstruct the pulp defects of the fingers between August 2003 and August 2004. The ages of patients ranged from 21 to 64 years. The sizes of the flaps ranged from 1 × 1.5 cm to 3 × 2 cm. The mean flap area was 3.2 cm². The arterialized venous free flap was an A-V type in all cases.

Every donor site was closed directly. Fifteen flaps (88.2%) survived; 2 flaps (11.8%) failed. Among the 15 flaps, 11 flaps survived without any complication. Four flaps showed partial marginal necrosis, but healed without an additional operation. The sensory recovery was relatively good. Static two-point discrimination ranged from 3 mm to 11 mm during the follow-up period.

The authors believe that the arterialized venous free flap using the thenar region as a donor is a good method for the reconstruction of pulp defects in fingers.