Thenar flaps for finger reconstruction. This is a somewhat unusual case of a patient with multiple degloving injuries, so that the index, middle, and ring finger have injuries, coverage is required for the index and middle finger. In this case, two thenar flaps will be elevated as separate flaps, one for coverage of the index finger and one for the middle finger. Because the defect will be too large to do with primary flap advancement for closure of the thenar component, split-thickness skin graft will be harvested. The site has been injected with marking with epinephrine to minimize bleeding. The graft is then meshed after the donor site has been dressed. Bleeding vessels in the flap are controlled. Skin graft is used to not only cover the bed where the flap has been harvested, but also the proximal portion of the fingers where the degloving has occurred where there's no tendon or bone exposed. This is an older patient who has bilateral total knee replacement, so groin flaps or abdominal flaps are avoided. In this case, the flaps are then sutured into place, and the PIP joints are pinned to prevent tension on the flaps. These will be removed when the flaps are divided at three weeks. Three weeks after applying the thenar flap, the Kirschner wires are removed, and the flap is then divided sharply. The flaps will be rotated and inset into position as demonstrated here with small chromic sutures. The remainder of the wounds can be debrided. They may require later skin grafting in this massive degloving injury. Range of motion exercises are started promptly.

finger reconstruction

thenar flaps

degloving injuries

split-thickness skin graft

range of motion exercises