Reverse thenar perforator flap for volar hand reconstruction

The glabrous skin of the palm provides the best colour and texture match for reconstructing volar hand defects, but only a limited number of local axial pattern flaps of the palm have been described in the literature. This report describes a new reverse thenar perforator flap harvested from the midpalm and the thenar region. A total of 12 patients with volar hand defects of the index finger, palm, or first web space were reconstructed with this flap between August 2005 and August 2007. The causes of the defects were trauma (one patient), burn contracture release of the first web and index finger (four patients), and Dupuytren contracture release (seven patients). The flap was supplied from one or two of the perforating branches of the terminal branch of the superficial palmar arch or the superficial palmar branch of the radial artery. Flap sizes ranged from 1.5 x 3.0 cm to 2.5 x 6.5 cm. The donor sites were repaired primarily in all patients. There were no major postoperative problems: 11 flaps out of 12 survived completely with just one partial loss. Excellent functional and cosmetic results were observed during a mean follow up of 12.6 months. The reverse thenar perforator flap offers glabrous skin for defects of the palm, first web and index finger. Donor scarring of the flap is minimal and it is suitable for the 'replacement with similar tissue' concept.