Partial or complete amputation of the thumb is extremely common and leads to significant impairment of hand function.1 Reconstruction is often challenging, and preservation of length, restoration of sensation, and stable soft-tissue coverage remain the goals of any reconstructive procedure. In 1964, Moberg described the palmar advancement flap to meet these goals.2 This flap was then later described for the coverage of defects less than or equal to 2 cm in longitudinal diameter at the palmar tip of the thumb,3 along with various modifications mainly to extend the possible mobilization of the flap.4 In oblique injuries, there is often a need to further shorten the remaining distal phalanx and nail bed to fashion a well-rounded tip and to allow suture of the flap distally to the nail bed. To minimize further shortening of the thumb, we describe the novel use of a composite Moberg flap that includes distal phalanx and nail bed matrix in reconstructing these defects.
A Moberg flap is designed and raised under general anaesthesia with tourniquet control. A small triangular segment of distal phalanx and nail bed matrix from the contralateral side of injury is included in the advancement flap and “flipped” into the defect (Fig. 1). The nail bed is repaired with a fine absorbable suture and the surrounding skin is trimmed to fashion a well-rounded tip and secured with nonabsorbable sutures. Excellent sensitivity and functionality are seen 12 months after surgery, with preservation of thumb length and normal nail growth. We have found this simple and elegant modification of the standard Moberg flap to be an excellent choice when faced with reconstructing complex injuries of the thumb tip.
The authors have no financial interest to declare in relation to the content of this communication.
Nanda Kandamany, M.R.C.S.
Anas Naasan, F.R.C.S.(Plast.)
Department of Plastic Surgery
Dundee, United Kingdom
1. Jones JM, Schenck RR, Chesney RB. Digital replantation and amputation: Comparison of function. J Hand Surg Am. 1982;7:183–189
2. Moberg E. Aspects of sensation in reconstructive surgery of the upper extremity. J Bone Joint Surg Am. 1964;46:817–825
3. Kleinman WB, Strickland JWGreen DP, Hotchkiss R, Pederson WC. Thumb reconstruction. Operative Hand Surgery. 19994th ed New York Churchill Livingstone:2068–2170 In:
4. Dellon AL. The extended palmar advancement flap. J Hand Surg Am. 1983;8:190–194
Viewpoints, pertaining to issues of general interest, are welcome, even if they are not related to items previously published. Viewpoints may present unique techniques, brief technology updates, technical notes, and so on. Viewpoints will be published on a space-available basis because they are typically less timesensitive than Letters and other types of articles. Please note the following criteria:
- Text—maximum of 500 words (not including references)
- References—maximum of five
- Authors—no more than five
- Figures/Tables—no more than two figures and/or one table
Authors will be listed in the order in which they appear in the submission. Viewpoints should be submitted electronically via PRS’ enkwell, at www.editorialmanager.com/prs/. We strongly encourage authors to submit figures in color.
We reserve the right to edit Viewpoints to meet requirements of space and format. Any financial interests relevant to the content must be disclosed. Submission of a Viewpoint constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the Journal and in any other form or medium.
The views, opinions, and conclusions expressed in the Viewpoints represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.