Not Just for Kids: A Systematic Review of Outcomes of the Thenar Flap

Abstract

Fingertip injuries are common, and the thenar flap is a well-described technique used to maintain digital length. However, its use in patients aged 30 years and above is generally discouraged due to concerns regarding postoperative joint contracture. The purpose of this review was to evaluate whether these concerns are substantiated. A search of PubMed, Embase, and SCOPUS (1947-2025) identified 15 studies involving 519 flaps. Case reports and studies lacking functional outcome data were excluded. Bias was assessed using the Methodological Items for Non-Randomized Studies instrument, and results were synthesized using Microsoft Excel. Joint contracture occurred in 32.4% of cases, all of which involved only the distal interphalangeal (DIP) joint. Active range of motion (AROM) at the metacarpophalangeal and proximal interphalangeal (PIP) joints remained near normal and comparable with contralateral finger values. Distal interphalangeal joint AROM was reduced by 14.1° compared with contralateral fingers. Patients older than 30 years demonstrated a 3° greater PIP joint AROM than younger patients (P = .02). Our analysis of the literature shows that there is an elevated risk of DIP joint contracture after thenar flap reconstruction of a fingertip injury, but this risk was not significantly different in patients above 30 years. Further investigation with larger studies and standardized outcomes assessment is recommended.