Comparison between Moberg Flap and Second Toe Pulp Free Flap for Coverage of Tip Amputation of Thumb

Jung, Gang Jae; Ki, Sae Hwi; Kim, Jin Soo; Lee, Dong Chul; Roh, Si Young; Yang, Jae Won

Abstract

PURPOSE: Transverse type or volar oblique type of defect of thumb tip can be covered by Moberg flap or second toe pulp free flap. We compared these two methods in functional result, patients' satisfaction, and sensation, etc. to find a better way to cover the defect of the thumb tip.
METHODS
From 2003 to 2006, we chose the patients randomly with preoperative pictures. The patients had the defect of the thumb tip which is either transverse or volar oblique type. The 6 patients were treated with Moberg flap and other 6 patients were treated with second toe pulp free flap. We have analyzed the results by 2 point discrimination, side pinching power test, pulp to pulp pinching power test, pain scales (visual analogue scale), satisfaction scales of the patients (functional and aesthetic), the degree of the range of motion, etc.
RESULTS
All flaps survived without any complications. In the cases of Moberg flaps, the value of static 2 point discrimination test was 5.6mm, and the value of moving 2 point discrimination test was 4.8mm. In the cases of second toe pulp free flaps, the values were 9.6mm and 9.3mm. In the cases of Moberg flaps, the value of the Side pinch power test was 6.6kg, 4.4kg. In the case of second toe pulp free flaps, the values were 4.8kg and 2.5kg. The value of aesthetic satisfaction scale of the patients in Moberg flaps was 5.6, the value of functional satisfaction scale of the patients was 3.6. In cases of second toe pulp free flaps, the values were 5.6 and 3.6. The active range of motion of Interphalangeal joint in the cases of Moberg flaps was 46.6 degree, and the active range of motion of metacarpophalangeal joint was 55 degree, in the cases of second toe pulp free flaps, the values were 36.6 degree and 59 degree.
CONCLUSION
As a result, when the defect of the thumb tip is transverse or volar oblique type, we suggest that the operators choose Moberg flap to cover the defect of the thumb tip.