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Not Just for Kids: A Systematic Review of Outcomes of the Thenar Flap
Camren S Toole, BS
1, Carlos R Martinez, MD, MPH
1; Joshua M Adkinson, MD
2(1)Indiana University School of Medicine, Indianapolis, IN, (2)Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN
Introduction: Fingertip injuries are common and the thenar flap is a well-described reconstructive technique used to maintain digital length. However, its use in patients over 30 years of age is generally discouraged due to concerns regarding postoperative joint contracture. This systematic review sought to evaluate whether such concerns are substantiated.
Materials/Methods: A search of PubMed, Embase, and SCOPUS (1947-2025) identified articles that reported any functional outcomes following thenar flap reconstruction. Case reports and studies lacking outcome data were excluded. Risk of bias was assessed using the MINORS instrument, and results were synthesized using Microsoft Excel.
Results: Fifteen studies involving 519 thenar flaps were identified that met inclusion criteria. Joint contracture occurred in 3.1% of cases and persisted in 2.1%. Active range of motion (AROM) at the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints remained near normal and comparable to contralateral finger values. Distal interphalangeal joint (DIPJ) AROM was below normal and reduced by 14.1° compared to contralateral fingers. Patients over 30 exhibited a 3° greater PIPJ AROM than younger patients (p=0.02).
Conclusion: These data suggest the thenar flap may be utilized for soft tissue reconstruction without significant risk for joint contracture, regardless of patient age. Findings, however, are limited by small sample size or inconsistent reporting. Further investigation with larger studies and standardized outcomes assessment is recommended.
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