Hand Surgery:Flexor Pollicis Brevis

The flexor pollicis brevis is an intrinsic muscle of the hand that originates from the flexor retinaculum of the wrist and tubercle of the trapezium. The muscle inserts on the radial side at the base of the proximal phalanx of the thumb. The recurrent branch of the median nerve and the deep branch of the ulnar nerve provide motor innervation that allows the flexor pollicis brevis to flex the thumb at the first metacarpophalangeal joint.

Laceration of the flexor pollicis brevis due to trauma significantly impairs hand function as the patient is unable to fully oppose the thumb to the small finger.

I prefer repairing the tendon of the flexor pollicis brevis tendon with 3.0 and 4.0 nylon suture with a modified Kessler stitch and horizontal mattress sutures. A 5.0 epitendinous suture allows an adequate contour to the repair and facilitates opposition of the thumb to the small finger.

Brian P. Dickinson, M.D.

http://www.drbriandickinson.com/

Microsurgery Notes

Recipient Vessels Veins:

1. Internal Mammary-3rd rib.
2. Internal Mammary – 2nd rib
3. External Jugular
4. Brachiocephalic
5. Thoracodorsal*

Diameters of Deep Inferior Epigastric Vessels- 2.5 mm
Pedicle Length- 5 cm

Coupler: Mobile to non-mobile (or)
Coupler: Diameter to be shortened 1st to match size discrepancy.

Perforator Flap (Venous Flow). Perforator Decision Tree

Palpable Pulse, No Venous Signal: +++
Arterial Signal, Venous Signal: +
No Arterial Signal, Venous Signal: ---

Harvest of DIEP Flap:

Vein
Artery
Vein

Anastamosis Clamps Off:

Venous Anastamosis
Arterial Anastamosis

Fill Test, Reflow Test

Doppler-Venous Augmentation Test