The Littler flap has been widely used to repair large pulp defects of the thumb; however, several complications have occurred frequently. In order to reduce these issues, the modified Littler flap innervated by the dorsal branch of the proper digital nerve and the proper digital nerve from the ulnar aspect of the middle finger or the radial aspect of the ring finger were devised in 16 consecutive cases. At the donor site, the defect of the proper digital nerve was repaired with a nerve graft from the proximal portion of the ipsilateral dorsal branch of the proper digital nerve. At the final follow-up, the scores for the static two-point discrimination test, Semmes-Weinstein monofilament test and total active motions in both recipient and donor fingers were nearly normal. This modified Littler flap provides a simple and reliable alternative for treatment of large defects of the thumb pulp with low donor-site morbidity.
Level of evidence: IV.
Keywords: Littler flap; Thumb pulp defect; dorsal branch; neurorrhaphy; proper digital nerve; thumb reconstruction.