FREE MUSCULOFASCIOCUTANEOUS MEDIAL PLANTAR FLAP FOR RECONSTRUCTION OFTHENAR DEFECTS

Functional reconstruction of thenar skin defects complicated by muscle loss is possible by transfer of a medial plantar flap with the underl ying abductor hallucis muscle. Three patients with severe flexion-addu ction contractures of the thumb due to gunshot injuries were reconstru cted by using this musculofasciocutaneous flap. At surgery, after rele ase of the skin contractures, all dysfunctional fibrotic muscles were excised. A medial plantar flap and the abductor hallucis muscle were d issected together; the motor branch of the abductor hallucis was prese rved by intraneural dissection and sutured to the thenar motor branch of the median nerve. The muscle ends were sutured across the defects o f the thenar muscles. All flaps survived without any loss at follow-up of 6-9 months, The flaps adapted to the thenar region completely by p roviding sufficient thenar bulk and a good skin colour match with palm ar skin. Electromyography of the transferred muscle showed an interfer ence pattern with an amplitude of about 200 mV in two cases and 100 mV in one case. Clinically, these findings were supported by voluntary o pposition of the thumbs with good strength.