Two-staged Lateral based Thenar Flap for Fingertip Injuries of Index and Middle Fingers –A Functional Outcome

Introduction: Fingertip injuries, particularly of the index and middle fingers, account for major accidents which occur in industrial regions due to machinery usage, causing sharp cuts or crush injuries of the tips. The treatment of these fingertip injuries previously was amputation and stump closure. As the advancement of flaps occurred, there came many flaps mentioned to treat these tip injuries. Many of these flaps had failed to provide the same functional and aesthetic outcome following surgery. This study aims at assessing laterally-based thenar flap for tip injuries of index and middle fingers for its aesthetic and functional outcome. Methods: This prospective study was done for fingertip injuries presenting to the emergency and OPD in 18 patients, with most involving the tip along with pulp loss. Patients were treated with laterally-based thenar flaps near the metacarpal base of thumb and subsequent release was done in all the patients as a second stage after 3 weeks. The results were assessed using static and dynamic 2 point discrimination and 4 point Likert scale and the total ROM of fingers was also assessed. Results: Majority of injuries were in males in the dominant hand in index finger (12 cases) with a mean age group of 28.2 years. Aesthetic appearance measured by Likert scale showed 3.9 at the end of 6 months (extremely satisfactory). The Mean Static and Dynamic 2-point discrimination for functional outcome was 7.44 and 6.42 respectively. Total ROM was measured on the injured side (234+/-3.66) and compared with the contralateral side (246+/-4.26), which statistically showed no significant difference in movement after the surgery. Conclusion: This study emphasizes that the thenar flap, which is laterally based at base of the thumb, has very good functional outcome and it resembles the lost pulp with thenar bulk, showing similar color and sensations. Also, this procedure can be done in a primary care setting with minimal resources and minimal plastic surgery exposure.