Reconstruction of Thumb Pulp Defects Using a Modified Kite Flap

Purpose We report on a modified kite flap for the reconstruction of thumb pulp defects. We performed nerve repair to improve thumb pulp sensation. Methods From May 2005 to December 2008, 42 thumbs in 42 patients were treated. The average size of the thumb pulp defects was 2.1 x 2.6 cm (range, 1.6 X 1.8 cm to 2.8 x 3.1 cm). The mean flap size was 2.5 X 2.9 cm (range, 1.8 X 2.2 cm to 3.2 X 3.5 cm). The radial branch of the second dorsal digital nerve was coapted to one of the proper digital nerves of the thumb. The required average length of the nerve branch was 1.2 cm (range, 0.7 to 1.6 cm). At follow-up, flap sensation was assessed using a static 2-point discrimination (2PD) test. For comparison, we also included 32 patients without nerve repair from April 2003 to April 2005. Outcomes were rated using the modified American Society for Surgery of the Hand Guidelines for Stratification of 2PD. Results In the study group, full flap survival was achieved in 40 thumbs, and partial distal flap necrosis was noted in 2 thumbs. At final follow-up (mean, 26 mo; range, 24 to 27 mo), we obtained a fair result, with a mean 2PD of 7.9 mm (range, 7 to 10 mm) on all flaps. In the comparison group without nerve repair, there were 26 fair and 6 poor results, with a mean 2PD of 12 mm (range, 8 to 18 mm) at final follow-up (mean, 24 mo; range, 22 to 26 mo). There was a highly significant difference between the 2 groups. Conclusions We suggest performing nerve repair to improve the sensation of the kite flap when reconstructing a thumb pulp defect. (J Hand Surg 2011;36A:1597-1603. Copyright (C) 2011 by the American Society for Surgery of the Hand. All rights reserved.)