The Moberg volar advancement flap for digital reconstruction

The volar advancement flap described by Moberg in 1964 has been used to restore normal sensation to soft tissue deficits of the thumb. Application of this same technique for finger tip injuries was later suggested by Snow, but differences in digital blood supply led to dorsal tip necrosis and selection of other reconstructive techniques by many surgeons. Other methods have the disadvantages of widened two-point discrimination, a tender pulp scar, or an unacceptable donor site. The volar advancement flap applied to fingers restores normal to nearly normal sensation, an adequate pulp with minimal deformity. Our experience with the volar advancement flap in 69 digits from 1969 to 1978 is reviewed. Preservation of the dorsal perforating vessels is most important in successfully executing this procedure. No dorsal tip or flap necrosis occurred. Two-point discrimination was normal or within 2 mm of contralateral values in every digit. Full range of motion, or less than 5 degrees extension loss, was recorded in all fingers that were normal prior to operation. Our results suggest this to be a safe as well as effective adjunct in the treatment of finger tip injuries.