The glabrous palmar flap: the new free or reversed pedicled palmar fasciocutaneous flap for volar hand reconstruction.

We devised a new flap using the palmar cutaneous branch of the superficial radial artery proximally and anastomosed with a cutaneous perforator of the superficial palmar arch distally. We named our flap "the volar glabrous palmar flap." The flap was used both as a free flap and as a reverse-flow island flap. Thirty-six patients with volar hand defects (24 digits, 7 palms, and 5 first web space) were reconstructed with this flap. The flap was used as a proximally based free flap in 15 patients and was used as a reverse-flow island flap based on distal communication in the remaining 21 patients. Free flaps were supplied by the palmar branch of the superficial radial artery and its fasciocutaneous extensions; reverse-flow island flaps were supplied by one of the perforating branches of the superficial palmar arch, which is connected to the proximal fasciocutaneous branches. Flaps extended from the wrist crease to the proximal palmar crease and were designed medially on the thenar crease, extending 2 to 2.5 cm laterally. Flap sizes ranged from 1.5 x 2.2 cm to 2.5 x 10 cm. The palmar cutaneous branch of the median nerve within the flap area was identified and then was sutured to the divided digital nerve in 6 cases of finger pulp defect. The donor sites were closed and repaired primarily in most cases. The postoperative course was uneventful, and all the flaps survived without major complications. Follow-up (minimum 6 mo, mean 24 mo) showed excellent functional and cosmetic results. Satisfactory sensory reinnervation was achieved in patients who underwent sensory flap transfer for pulp defects. At the same time, we studied 6 cadaver hands to understand the vascular anatomy of the thenar area of the hand. We also revised several published anatomic papers to obtain a refined and scrutinized understanding of the palmar anatomy.