• Archives of Plastic Surgery
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• v.47 no.5
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• pp.435-443
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• 2020

Background The innervated radial artery superficial palmar branch (iRASP) flap was designed to provide consistent innervation by the palmar cutaneous branch of the median nerve (PCMN) to a glabrous skin flap. The iRASP flap is used to achieve coverage of diverse volar defects of digits. However, unexpected anatomical variations can affect flap survival and outcomes. Methods Cases in which patients received iRASP flaps since April 1, 2014 were retrospectively investigated by reviewing the operation notes and intraoperative photographs. The injury type, flap dimensions, arterial and neural anatomy, secondary procedures, and complications were evaluated. Results Twenty-eight cases were reviewed, and no flap failures were observed. The observed anatomical variations were the absence of a direct skin perforator, large-diameter radial artery superficial palmar branch (RASP), and the PCMN not being a single branch. Debulking procedures were performed in 16 cases (57.1%) due to flap bulkiness. Conclusions In some cases, an excessively large RASP artery was observed, even when there was no direct skin perforator from the RASP or variation in the PCMN. These findings should facilitate application of the iRASP flap, as well as any surgical procedures that involve potential damage to the PCMN in the inter-thenar crease region. Additional clinical cases will provide further clarification regarding potential anatomical variations.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.663-668
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• 2011

Purpose: A modified free thenar flap was designed for coverage of volar finger defect with constant innervation using the palmar cutaneous branch of the median nerve. After clinical application of this flap, sensory results were evaluated in 6 cases. Methods: Patients were selected who have volar soft tissue defect with or without fingertip defect. The six cases of the innervated free thenar flap were performed since September 2009, and sensory outcomes were evaluated by the Semmes-Weinstein monofilament and two-point discriminator at four and half month after the surgery. Results: The Semmes-Weinstein Monofilament test revealed 3 cases showed 2.83, 1 case showed 3.61, 1 case showed 4.31 and 1 case showed 4.56. The static two-point discrimination test revealed 1 case showed 4 mm, 1 case showed 6 mm, 2 cases showed 9 mm, and 2 cases showed over 15 mm. The moving two-point discrimination test revealed 1 case showed 3 mm, 1 case showed 4 mm, 1 case showed 5 mm, 1 case showed 7 mm, and 2 cases showed over 15 mm. The donor sites showed no significant limitation of the thumb and neuroma formation. Conclusion: The innervated free thenar flap showed good sensory outcomes as a sensate free flap in a short time after surgery. It can be an option for coverage of volar finger defects that requires sensation.