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Resurfacing Hemipulp Losses of the Thumb: The Cross Finger Flap Revisited: Indications, Technical Refinements, Outcomes, and Long-Term Neurosensory Recovery

Woon, Colin Yi-Loong MBBS, MRCSEd, MMed (Surg); Lee, Jonathan Yi-Liang MB, BCh BAO, MRCSEd, MMed (Surg), FAMS; Teoh, Lam-Chuan MBBS, FRCS (Glasg), FAMS

doi: 10.1097/SAP.0b013e3181640873
Hand Surgery and Microsurgery

Volar-oblique injuries of the thumb pulp are particularly disabling. Many methods have been described to treat these injuries and provide return of sensibility. The conventional cross finger flap is an established technique and is well suited for intermediate-sized partial pulp losses. We review our experience with this flap and describe technical refinements that have contributed to improved early outcome and long-term neurosensory recovery.

Thirty patients underwent 31 cross finger flaps to the thumb for volar-oblique pulp defects. Defect sizes ranged from 1.5 to 5 cm in length and 1.5 to 3 cm in width. Dorsal skin of the index finger proximal phalanx was used in 26 patients, index finger middle phalanx in 2 patients, and long finger middle phalanx in 3 patients. Nine patients were available for long-term follow-up and were subjected to functional assessment (DASH questionnaire), sensitivity testing (2-point discrimination, Semmes-Weinstein monofilament testing), and range of motion evaluation.

Thirty of 31 flaps survived. In 1 patient, trauma to the attached flap from the long finger middle phalanx resulted in flap ischemia. This was revised with a fresh cross finger flap from the index finger proximal phalanx. Employed patients were able to return to their original jobs. Recalled patients (n = 9) were assessed at a mean of 29 months after surgery (range, 12–70 months). All recalled patients regained normal sensibility on 2-point discrimination testing. Functional outcome was satisfactory in 8 patients (DASH score, 0–20). The last patient (DASH score, 61.67) complained of hypersensitivity and cold intolerance that affected his work.

The conventional cross finger flap provides reliable coverage for volar-oblique hemipulp losses of the thumb, with patients regaining at least protective sensibility in the long term. The proximal and middle phalanges of both the index and long fingers may serve as donor sites, allowing the surgeon to best select skin cover based on defect size and options in finger positioning.

From the Department of Hand Surgery, Singapore General Hospital, Singapore.

Received August 14, 2007 and accepted for publication, after revision, December 3, 2007.

Reprints: Dr Colin Woon, Department of Hand Surgery, Singapore General Hospital, Singapore 169608. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.