Clinical application of reverse greater thenar flaps and its effect on sensory function recovery of thumbs

Objective To study the clinical application of reverse greater thenar flaps and the effect of different flaps with nerves on sensory function recovery of thumbs. Methods Forty-three patients aged 17-52 years with partial defects of thumb who underwent three kinds of reverse greater thenar flap in May 2006-August 2010 in Baoding First Central Hospital and Chinese PLA 252 Hospital were divided into group A（n=14）,group B（n=14）,and group C（n=15）.The maximum and minimum size of flaps was 1.5cm×2.0cm and 3.5cm×4.0cm respectively.Of the 43 patients,33 underwent reverse flap transplantation and nerve transposition.Reverse flaps with superficial branches of radial nerve and palmer branches of median nerve were transplanted to recover the sensory function of their thumbs.The patients were followed up for 0.5-2 years（mean 10 months）.The survival rate,blood circulation and texture,sensory function recovery of thumbs after transplantation of 3 different flaps were assessed and compared. Results All the transplanted flaps survived with good blood circulation,soft texture,and good elasticity.The sensory function of thumbs was completely recovered.Of the 10 patients who did not undergo nerve transposition,6 had their sensory function of thumbs recovered as S₂ and 4 as S₁.Of those who underwent flap transplantation with superficial branches of radial nerve,3 had their sensory function of thumbs recovered as S₃ and 16 as S₃⁺.Of those who underwent flap transplantation with the palmer branches of median nerve,9 had their sensory function of thumbs recovered as S₃ and 5 as S₃⁺（P＜0.05）. Conclusion Reverse greater thenar flaps can repair the defects of thumbs.The effect of reverse flap transplantation with the superficial branches of radial nerve is better than that of reverse flap transplantation with the palmer branches of median nerve.