Thenar flap: a workhorse flap for fingertip injuries

Abstract

Introduction: Fingertip injuries are the most common type of upper limb trauma, frequently involving volar oblique or transverse defects with exposed bone or tendon. The thenar flap, first described in 1926, remains a reliable and aesthetically favorable option for reconstruction, particularly for index, middle, and ring finger injuries. Despite concerns about joint stiffness and donor site morbidity, refinements in surgical technique have improved outcomes. Methods: A retrospective study was conducted at a tertiary care center from January 2023 to January 2025. Twenty-five patients with traumatic fingertip injuries involving pulp loss or volar oblique/transverse defects underwent reconstruction using tailored thenar flap techniques. Functional recovery was assessed via range of motion (ROM) at the metacarpophalangeal joint (MCPJ) and the proximal interphalangeal joint (PIPJ) and static two-point discrimination (2PD). Aesthetic and subjective satisfaction were measured using a five point Likert scale during a 6-month follow-up. Results: Among 25 patients (76% male, median age 25 years), the most common injuries were volar oblique (40%) and involved the index finger (56%). Successful flap survival was noted in all cases, with minimal complications. Mean ROM at the MCPJ and PIPJ was 99.92° and 95.36°, respectively. Mean 2PD over reconstructed fingertips was 5.49 mm. Aesthetic satisfaction was high, with 88% of patients rating outcomes as "satisfied" or "very satisfied." Only one patient developed a flexion contracture due to physiotherapy noncompliance. Conclusion: The thenar flap remains a versatile, safe, and effective option for fingertip reconstruction when performed with proper technique and rehabilitation. It offers excellent functional recovery and aesthetic outcomes, making it a valuable tool across varying age groups.