Moberg modification using the first web space: thumb reconstruction following distal amputation

Excerpt

The Moberg neurovascular advancement flap, first described in 1964, has proven to be ideal for soft tissue defects of the thumb pulp measuring ≤1.5 cm in size [8]. For such small defects, this technique provides sufficient skin coverage allowing preservation of length and most importantly good restoration of sensation and function [2, 5]. Modifications to the Moberg flap have allowed coverage of deficits >1.5 cm but have been hampered by the residual defect located at the donor site. In 1968, O’Brien proposed the use of a split thickness skin graft to cover the donor deficit [9]. The disadvantages of a skin graft such as immobilization, risk of graft failure, and contracture render this technique less attractive. Others have avoided grafting with V–Y modifications to the Moberg flap [1, 3, 4, 10]. However, tension at the donor site often occurs and may result in incomplete closure or in skin necrosis. In these instances, splinting in the flexed position to decrease tension or dressing changes to encourage epithelialization when complete primary closure is not feasible is required [4, 7]. As a consequence, scar hypertrophy, contractures, joint stiffness, and delayed mobilization may prolong return to function. Dellon demonstrated that defects of up to 3 cm could be resurfaced using an extended palmar flap with dissection into the thenar eminence [3]. Two rotational flaps are used to close the donor deficit. Although providing good closure, this technique requires extensive dissection and is technically difficult. …