# Donor-Site Morbidity Analysis of Thenar and Hypothenar Flap

## TL;DR

This study compares the donor-site complications of thenar and hypothenar free flaps for small skin defects, finding higher pain and scarring with thenar flaps but similar satisfaction.

## Contribution

The study provides a comparative analysis of donor-site morbidity between thenar and hypothenar free flaps using clinical outcome measures.

## Key findings

- Thenar flaps showed higher general pain, neuropathic pain, and scar scores compared to hypothenar flaps.
- Patient satisfaction was slightly higher for hypothenar flaps but not statistically significant.
- Flap width had no notable impact on outcome measures.

## Abstract

Background
 For the small glabrous skin defect, Thenar and Hypothenar skin are useful donors and they have been used as a free flap. Because of similar skin characteristics, both flaps have same indications. We will conduct comparative study for the donor morbidity of the Free thenar flap and Hypothenar free flap.

Methods
 From January 2011 to December 2021, demographic data, characteristics of each flap, and complications using retrospective chart review were obtained. Donor outcomes of the patient, who had been followed up for more than 6 months, were measured using photographic analysis and physical examination. General pain was assessed by Numeric Rating Scale (NRS) score, neuropathic pain was assessed by Douleur Neuropathique 4 Questions (DN4) score, scar appearance was assessed by modified Vancouver Scar Scale (mVSS), and patient satisfaction was assessed on a 3-point scale. Statistical analysis was performed on the outcomes.

Results
 Out of the 39 survey respondents, 17 patients received Free thenar flaps, and 22 patients received Hypothenar free flaps. Thenar group had higher NRS, DN4, and mVSS (
p
 < 0.05). The average scores for the Thenar and Hypothenar groups were 1.35 and 0.27 for NRS, 2.41 and 0.55 for DN4, and 3.12 and 1.59 for mVSS, respectively. Despite the Hypothenar group showing greater satisfaction on the 3-point scale (1.82) compared with the Thenar group (1.47), the difference was not significant (
p
 = 0.085). Linear regression analysis indicated that flap width did not have a notable impact on the outcome measures, and multiple linear regression analysis revealed no significant interaction between flap width and each of the outcome measures.

Conclusion
 Despite the limited number of participants, higher donor morbidity in general pain, neuropathic pain, and scar formation was noted in the Thenar free flap compared with the Hypothenar free flap. However, no difference in overall patient satisfaction was found between the two groups.