Outcomes Associated with Moberg and Modified Moberg Flaps in Thumb Reconstruction: A Systematic Review

Abstract

Background: Appropriate thumb function is critical as it is makes up approximately 40% of the hand's function leading to the greatest influence in activities of daily living (ADLs). Local flaps are the primary option for thumb reconstruction, of which the Moberg flap has been reported to have the added advantage of its advancement capacity relative to other flaps. This systematic review aims to describe the outcomes of the Moberg advancement flap and its associated modifications for coverage of palmar thumb defects. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for the conduct of this systematic review. Medline, Embase, CINAHL and Cochrane Library were systematically searched to retrieve relevant citations. Title and abstract as well as full-text assessment were performed in duplicate. Full texts were extracted by one reviewer and data extracted was confirmed by a second. Complication rates and overall means were calculated for the appropriate outcomes. Results: A total of 1,794 citations were retrieved; 15 papers were retained, including 169 patients. The overall mean follow-up was 28.6 months (n = 5 studies). In 136 patients, there was 100% flap viability (n = 12 studies). With regard to thumb aesthetics, 92% (59/64 patients) had favourable outcomes (n = 6 studies). No evidence of postoperative flexion contractures (n = 0/56 patients, 5 studies) was found. Cold intolerance occurred at a rate of 29.8% (n = 17/57, 4 studies) and the infection rate was 10.3% (6/58 patients, 3 studies). Conclusions: Moberg/modified Moberg flaps are a safe option for thumb reconstruction given their associated postoperative outcome and complication profile. Level of Evidence: Level III (Therapeutic)