Moberg Flap in the Reconstruction of Allen Type III Thumb Tip Injuries: A Case Report
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Abstract
Background: Thumb tip injuries involving soft tissue loss and bone exposure represent a reconstructive challenge due to the need to preserve digital length, restore sensibility, and maintain pinch function. The Moberg flap (bilateral volar neurovascular advancement flap) is a classic reconstructive option that provides sensate glabrous skin and durable coverage for selected distal defects.
Case Report: We present the case of a 25-year-old male patient with a transverse right thumb tip injury classified as Allen type III, secondary to an avulsion mechanism, with a 1.5 × 2.0 cm defect and distal bone exposure. Reconstruction was performed using a Moberg flap, achieving complete defect coverage without additional bone shortening. Postoperative management included early mobilization and a progressive rehabilitation protocol.
Results: The flap demonstrated complete survival with adequate preservation of digital length and favorable clinical evolution. Follow-up revealed recovery of sensibility, preserved joint mobility, and progressive functional reintegration, with no evidence of necrosis, significant joint stiffness, or major complications.
Conclusion: The Moberg flap remains a reliable and effective reconstructive technique for Allen type III thumb tip injuries with bone exposure. Proper indication and meticulous surgical execution allow for satisfactory functional outcomes, reinforcing its role as a first-line option for distal thumb reconstruction.
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References
I. Baumeister, S., Menke, H., Wittemann, M., & Germann, G. (2002). Functional outcome after the Moberg advancement flap in the thumb. The Journal of Hand Surgery (American Volume), 27(1), 105–114.
https://doi.org/10.1053/jhsu.2002.30921
II. Bang, H., & Louis, D. S. (1992). Palmar advancement flap with V-Y closure for thumb tip reconstruction. The Journal of Hand Surgery.
III. Choughri, H., & colaboradores. (2009). A technical tip of the O’Brien volar advancement flap for thumb reconstruction. Journal of Plastic, Reconstructive & Aesthetic Surgery, 62(6), e176–e177. https://doi.org/10.1016/j.bjps.2008.09.022
IV. Dellon, A. L. (1983). The extended palmar advancement flap. The Journal of Hand Surgery (American Volume), 8(2), 190–194. https://doi.org/10.1016/S0363-5023(83)80014-8
V. Elsewify, O. (2023). Outcomes of the Moberg advancement flap and its modifications for coverage of palmar thumb defects: A systematic review. The Journal of Hand Surgery (Asian-Pacific Volume).
VI. Foucher, G., & colaboradores. (1999). Long-term outcome of neurovascular palmar advancement flaps for thumb tip coverage. Journal of Plastic, Reconstructive & Aesthetic Surgery (JPRAS).
VII. Germann, G., & colaboradores. (2015). Management of thumb tip injuries. The Journal of Hand Surgery.
VIII. Macht, S. D., & Watson, H. K. (1980). The Moberg volar advancement flap for digital reconstruction. The Journal of Hand Surgery (American Volume), 5(4), 372–376. https://doi.org/10.1016/S0363-5023(80)80179-1
IX. Moberg, E. (1964). Aspects of sensation in reconstructive surgery of the upper extremity. The Journal of Bone and Joint Surgery. American Volume, 46, 817–825.
X. Mutaf, M. (2012). Island volar advancement flap for reconstruction of thumb pulp defects. [Revista/Journal en PubMed].
XI. O’Brien, B. (1968). Neurovascular island pedicle flaps for terminal amputations and digital scars. British Journal of Plastic Surgery, 21(3), 258–261. https://doi.org/10.1016/S0007-1226(68)80033-5
XII. Thibaudeau, S., & colaboradores. (2012). Moberg modification using the first web space: Thumb reconstruction following distal amputation. HAND, 7(2).
XIII. Yassin, A. M., & colaboradores. (2022). Workhorse flaps for thumb reconstruction. [Artículo de revisión en cirugía reconstructiva de mano].
XIV. Alyamani, A. M. (2022). Moberg volar advancement flap. En O. Almeshal, S. Aldekhayel, & F. Alshomer (Eds.), Soft Tissue Reconstruction of the Hand: Loco-regional and Distant Flaps Selection and Approach (capítulo). Springer.
XV. Lee, K. J., & colaboradores. (2025). Thumb tip reconstruction using a modified Moberg flap. Journal of Wound Management and Research