Chapter 34 Table 34.1 Volar advancement flap (Moberg)
Volar Advancement Flap (Moberg)
Flap | Volar advancement flap (Moberg); O’Brien modification |
Tissue | Skin |
Course of the vessels | Underneath the flap |
Dimensions | Can reach the dimension of the entire volar surface of a digit or the thumb |
Extensions and combinations | – |
Anatomy |
|
Neurovascular pedicle | – |
Artery | Proper digital artery |
Veins | Concomitant veins of the digital artery |
Length and arc of rotation | Maximal defect size: longitudinal; mobilization: 1.5–2 cm |
Diameter | – |
Nerve | Proper digital nerves |
Surgical technique |
|
Preoperative examination and markings | Midlateral skin markings; the digital Allen test is recommended |
Patient position | Hand on arm table to avoid tourniquet ischemia |
Dissection | Moberg: midlateral incision; identification of the neurovascular bundles; unilateral preservation of the dorsal branches; volar advancement; distal flap fixation with a needle; frequently the flexion of the digit is necessary to allow for the closure of the defect |
Advantages |
|
Flap | Sensate flap to restore sensibility of the pulp |
Dissection | Straightforward and simple |
Vascular pedicle | Reliable |
Flap size and shape | Pulp defects of 1.5–2 cm |
Disadvantages |
|
Flap | Only small to midsize defects |
Donor site morbidity | Flexion contracture may occur if defect is too large and mobilization has not been sufficient |
Pearls and pitfalls |
|
Dissection | Preserve the dorsal collaterals on one side; suture the flap distally only with the needle to avoid further tension and impairment of the distal flap supply; a relaxing incision can be made at the base of the thumb or converted into an O’Brien modification to reduce the risk of flexion contracture, especially in older patients; insert a Z-plasty into a regular Moberg flap to avoid tension at the flap base |
Extensions and combinations | – |
Contouring and correction | Extremely rare |
Clinical applications | Defects of the pulp of the thumb |
