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.
