The major disadvantages of local flaps are a limited amount of advancement (5-10 mm distal tissue advancement is possible),  limited size of the flaps, deficiency of pulp sensitivity due to the scar line (V-Y flap), and failure to include the nerve into the flap (thenar
It supplies most forearm flexors and thenar
muscles and provides sensory innervations to the lateral aspect of palm and dorsal surfaces of terminal phalanges along with the palmer surface of thumb, index, middle, and half of ring fingers.
The surgical procedure was a direct microsurgical approach with a 1.5 cm incision in the thenar
sulcus, under local anesthesia (3 cc, 2% lidocaine) administered with an insulin needle.
We also noticed atrophy of the right thenar
muscle as an associated anomaly in GS.
(2) Median nerve--at thenar
eminence, volar surface of distal phalanx of the thumb and volar surface of distal phalanx of the index finger
On physical examination the affected hand may look normal, but sensory lost and thenar
muscle weakness or wasting may be evident (Walker, 2010).
There was a decreased sensation to light touch and pain (pin prick) in the palmar surfaces of the right thenar
eminence and right D2.
At physical examination, there was muscle atrophy in thenar
and hypothenar areas of the palm, and interosseus muscles in both hands, as well as in lower limbs.
The palm was gently pressed between intermetacarpal groove at the root of fingers, and on the dorsal side corresponding to thenar
and hypothenar regions.
Those include: pain, numbness, tingling, thenar
muscle wasting, eakness, nocturnal exacerbations and difficulty grasping items.
The patient was placed in a prone position while the chiropractor performed a prone, cross bilateral manipulation with thenar
contact to double transverse processes of the thoracic spine.