[Surgical flap according to Littler (neurovascular island flap)].

[OBJECTIVE] Defect coverage of medium-sized soft tissue defects on the ulnar side of the thumb and radial side of the index finger. By using the Littler flap, both, the lost soft tissue coverage and sensitivity, which is necessary for an exact grip to the long fingers, can be simultaneously restored.

[INDICATIONS] Medium-sized soft tissue defect of the ulnar tip of the thumb, exposed bones and parts of the tendons, extensive soft tissue defects with sensory deficit.

[CONTRAINDICATIONS] Limiting accompanying injuries of the hand.

[SURGICAL TECHNIQUE] All-layer incision of the flap at ulnar 3rd digit with proximal exploration of the nerve and vascular bundle. Tracing the bundle to the exit from the palmar arch. After subcutaneous tunneling, shift of the flap into the defect.

[POSTOPERATIVE MANAGEMENT] Immobilization of the thumb in adduction for 7 days in a dorsal plaster splint, followed by free exercise.

[RESULTS] Reliable defect coverage with low donor-site morbidity and immediate restoration of sensibility in the ulnar tip of the thump. However, microsurgical dissection, especially of the nerve, is challenging.