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Published on: March 1, 2015
Modified Free Functional Muscle Transfer for Thenar Reconstruction After High Pressure Injection Injuries: A
Hao Lu1, Xingxing Suo2, Haifeng Shi1
1Department of Hand Surgery, Wuxi NO.9 People's Hospital Affiliated to Soochow University.
Background:
High-pressure injection injuries of the hand can cause deep tissue destruction despite a small entry wound. When the thenar region is involved, radical debridement may leave a combined defect involving skin, dead space, and intrinsic muscle loss. Conventional treatment usually focuses on infection control and soft-tissue coverage, whereas the restoration of active thumb abduction and opposition is less commonly addressed.
Methods:
We retrospectively reviewed 10 patients with thenar high-pressure injection injuries treated between March 2023 and April 2025. After staged debridement and infection control, reconstruction was performed using a composite free muscle-skin flap based on 1 or more muscle segments harvested from the superficial portion of the vastus lateralis. The surgical design emphasized preoperative ultrasonographic estimation of the thenar muscle defect, chimeric flap harvest, dead space filling, tension-adjusted muscle fixation, and neurovascular anastomosis. Postoperative outcomes were evaluated by flap survival, wound healing, sensory recovery, muscle strength, thumb abduction, musculoskeletal ultrasonography, and donor-site morbidity.
Results:
All flaps survived completely, and all wounds healed primarily. Follow-up ranged from 4 to 12 months, with a mean of 8 months. The reconstructed thenar region had a satisfactory contour and soft texture, and no secondary debulking was required. Protective sensation recovered in all patients, with static 2-point discrimination ranging from 7 to 10 mm. Thumb muscle strength recovered to M5 in 6 patients and M4 in 3 patients. According to thumb abduction and opposition assessment, 5 patients had excellent results, 4 had good results, and 1 had a fair result. Postoperative ultrasonography demonstrated contraction of the transferred muscle. No obvious donor-site complication or knee dysfunction was observed.
Conclusions:
A modified free functional muscle transfer using the superficial portion of the vastus lateralis can provide simultaneous wound coverage, dead space obliteration, and dynamic thenar reconstruction after severe high-pressure injection injuries. This technique is not intended to replace established methods in all cases, but it may be useful when the thenar defect is contaminated, irregular, and associated with extensive intrinsic muscle loss.
