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

Abstract

Introduction: Fingertip injuries are common and the thenar flap is a well-described 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. The purpose of this review was to evaluate whether these concerns are substantiated. Methods: 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 MINORS instrument, and results were synthesized using Microsoft Excel. Results: 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 (MCP) and proximal interphalangeal (PIP) joints remained near normal and comparable to contralateral finger values. DIP joint AROM was reduced by 14.1° compared to contralateral fingers. Patients over 30 demonstrated a 3° greater PIP joint AROM than younger patients (p=0.02). Conclusion: 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 over age 30. Further investigation with larger studies and standardized outcomes assessment is recommended.