[Moschella island flap for coverage of thumb defects].

OBJECTIVE

The homodigital island flap according to Moschella is used to cover palmar and radiodorsal soft tissue defects of the thumb.

INDICATIONS

Soft tissue reconstruction of the thumb with exposed bone and/or tendon if reconstruction of the soft tissue is required.

CONTRAINDICATIONS

Extensive scars in the harvesting area of the flap; vascular occlusions of the radial artery.

SURGICAL TECHNIQUE

After Doppler sonographic imaging of the origin of the vessel radially at the thumb, the pivot point is determined. The flap is then cut from ulnar to radial, including the dorsoradial artery of the thumb. Removal of the origin of the vessel from the radial artery in the tabatiére and preparation from proximal to distal to the pivot point of the flap at the junction of the artery with the palmar vessels. If necessary, a part of the skin can remain palmar to the pivot point to improve venous drainage. The donor site of the flap can primarily close defect sizes up to 5 × 4 cm.

POSTOPERATIVE MANAGEMENT

Until wound healing, soft cotton dressing should protect the vascular pedicle from pressure; immobilisation on a palmar splint may be helpful.

RESULTS

In 9 men, sufficient soft tissue reconstruction of thumb defects could be achieved with the described Moschella flap. Eight patients had additional injuries to the fingers and hand.