This article describes the author’s experience with hypoplastic thumb reconstruction and opponensplasty in 14 patients using the pedicled abductor digiti minimi myocutaneous flap. The primary indications for transfer were inadequate thumb opposition and aplastic palmar and thenar soft tissues. Retrospective analysis revealed that all transfers survived and provided successful thumb opposition. Key pinch strength was 40% of normal and the use of the skin paddle provided improved thenar bulk and appearance.
In children with congenital hypoplastic thumbs and aplastic soft tissues of the palm and thenar region, the ADM myocutaneous flap is a good alternative to the traditional muscle transfer for restoration of opposition. The benefits of this flap are that it enhances appearance by providing bulk of the thenar eminence and eliminates the possibility of muscle ischemia caused by swelling within a tight tunnel.