[The thenar flap]

In covering amputations of fingertips several methods, including free grafts and local flaps have proven useful. When the amputation is at a more proximal level near the cuticle closure of the wound is often accomplished by further shortening of the distal phalanx and eradication of the nail matrix in order to avoid a claw-like deformity of the nail. This results in a unpleasant stump of poor prehensile quality. Therefore attention is called to the distal thenar flap which offers all the advantages of the palmar flap e. g. adequate subcutaneous tissue for reconstruction of a fingertip, good texture and colour match and a great potential for recovery of sensation. To avoid permanent stiffness of the PIP joint the flap is fashioned well distally on the thenar eminence with the base on the radial side. Immobilisation is secured by means of a plaster cast with the thumb in full palmar abduction and the MP joint of the recipient finger in full flexion. This leaves the PIP joint in but moderate flexion. The base of the flap is severed at two weeks.