Reverse vascular pedicle digital island flap with preservation of the dorsal branch of the digital nerve

Abstract Objective: To investigate the surgical method and therapeutic effect of retrograde island flap bridge transfer of adjacent phalangeal artery combined with vascular pedicle tubular skin grafting to repair finger pulp defect.Methods: From June 2008 to May 2020, 14 patients (16 fingers) with severe contusion of proximal and middle phalangeal body combined with finger pulp defect, and 5 patients (5 fingers) with finger pulp defect more than distal interphalangeal joint were repaired by retrograde island flap bridge transfer of adjacent phalangeal artery combined with vascular pedicle tubular skin grafting. The dorsal branch of digital nerve was carried in the skin flap for anastomosis with the proper nerve at the stump of the injured finger. The donor area was covered with medium thickness skin of abdominal or elbow transverse stripes, and the vascular pedicle was wrapped with tubular skin. The pedicle was severed 16-22 days after surgery. The survival rate and complications of postoperative flaps were observed. The finger function was evaluated by the Michigan functional questionnaire and Dagan functional criteria, and the clinical effect was evaluated. Result: All flaps survived and all patients were followed up for a period of 6 to 46 months. The skin flap of the affected finger was of good texture, and the appearance was naturally not bloated. The two-point discrimination was 7 ~ 11mm, and no obvious complications were observed in the donor area. Evaluation of the Michigan Hand Function Questionnaire: Nineteen patients were satisfied with the overall appearance and function of the hand. Finger joint Dargan function evaluation: excellent in 15 cases, good in 4 cases.Conclusions: It is a safe and effective operation to repair finger pulp defect with the retrograde island flap of adjacent finger artery combined with vascular pedicle tubular skin grafting. the skin flap has the advantages of simple cutting, good texture and concealed donor area, which is convenient for the early functional exercise of the finger body.

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A Comparison of the Dorsal Digital Island Flap with the Dorsal Branch of the Digital Nerve versus the Dorsal Digital Nerve for Fingertip and Finger Pulp Reconstruction

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000000057 ◽

2014 ◽

Vol 133 (2) ◽

pp. 165e-173e ◽

Cited By ~ 7

Author(s):

Chao Chen ◽

Peifu Tang ◽

Xu Zhang

Keyword(s):

Island Flap ◽

Digital Nerve ◽

Dorsal Branch

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Hypothenar island flap: A safe and excellent choice for little finger defects

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.173127 ◽

2015 ◽

Vol 48 (03) ◽

pp. 288-292 ◽

Cited By ~ 1

Author(s):

Mehmet Tapan ◽

Murat Iğde ◽

Ali Rıza Yıldırım ◽

Yağmur Yaprak Balı ◽

Sedat Yılancı ◽

...

Keyword(s):

Soft Tissue ◽

Clinical Results ◽

Island Flap ◽

Vascular Pedicle ◽

Soft Tissue Defects ◽

Texture Match ◽

Tissue Defects ◽

Little Finger ◽

Clinical Cases

ABSTRACTSoft-tissue defects of the little finger are challenging especially when bone, tendon or vascular pedicle is exposed because of trauma. The hypothenar island flap is easy to harvest and has a good colour and texture match to the little finger pulp. We present nine clinical cases of soft tissue defects of the little finger covered using the reversed hypothenar fasciocutaneous island flap. This article intends to highlight the ease of elevation and good clinical results of the hypothenar flap which is rarely used.

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Modified Littler flap for sensory reconstruction of large thumb pulp defects

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417754191 ◽

2018 ◽

Vol 43 (5) ◽

pp. 546-553 ◽

Cited By ~ 3

Author(s):

Hui Wang ◽

Xiaoxi Yang ◽

Chao Chen ◽

Bin Wang ◽

Wei Wang ◽

...

Keyword(s):

Donor Site ◽

Ring Finger ◽

Middle Finger ◽

Donor Site Morbidity ◽

Digital Nerve ◽

Level Of Evidence ◽

Dorsal Branch ◽

Ulnar Aspect ◽

Monofilament Test

The Littler flap has been widely used to repair large pulp defects of the thumb; however, several complications have occurred frequently. In order to reduce these issues, the modified Littler flap innervated by the dorsal branch of the proper digital nerve and the proper digital nerve from the ulnar aspect of the middle finger or the radial aspect of the ring finger were devised in 16 consecutive cases. At the donor site, the defect of the proper digital nerve was repaired with a nerve graft from the proximal portion of the ipsilateral dorsal branch of the proper digital nerve. At the final follow-up, the scores for the static two-point discrimination test, Semmes–Weinstein monofilament test and total active motions in both recipient and donor fingers were nearly normal. This modified Littler flap provides a simple and reliable alternative for treatment of large defects of the thumb pulp with low donor-site morbidity. Level of Evidence: IV

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Modified first dorsal metacarpal artery island flap for sensory reconstruction of thumb pulp defects

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415610529 ◽

2015 ◽

Vol 41 (2) ◽

pp. 177-184 ◽

Cited By ~ 15

Author(s):

H. Wang ◽

C. Chen ◽

J. Li ◽

X. Yang ◽

H. Zhang ◽

...

Keyword(s):

Island Flap ◽

Control Group ◽

Terminal Branch ◽

Level Of Evidence ◽

Mean Values ◽

Dorsal Branch ◽

Dorsal Metacarpal Artery ◽

Sensory Reconstruction ◽

First Dorsal Metacarpal Artery

Restoration of tactile sensation after reconstruction of a thumb pulp defect is import for hand function. We describe our clinical experience using a modified first dorsal metacarpal artery island flap innervated by the radial dorsal branch of the proper digital nerve and the terminal branch of the superficial radial nerve in 20 consecutive cases. The results were compared with 25 patients treated by the conventional Foucher’s first dorsal metacarpal artery flap without nerve repair. At the final follow-up, flap sensation was assessed using static two-point discrimination and Semmes–Weinstein monofilament testing. All flaps survived uneventfully in both groups. At the final follow-up, the mean values for static two-point discrimination and Semmes–Weinstein monofilament testing in the study group were significantly different from the values in the control group. The modified first dorsal metacarpal artery island flap provides a reliable and simple option for sensory reconstruction of thumb pulp defects. Level of evidence: Therapeutic, level III

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Does nerve repair influence the outcome of reconstruction of a digital nail defect using a free composite flap taken from the great toe?

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193414532806 ◽

2014 ◽

Vol 40 (6) ◽

pp. 583-590 ◽

Cited By ~ 1

Author(s):

X. Zhang ◽

C. Chen ◽

Y. Li ◽

X. Shao ◽

W. Guo ◽

...

Keyword(s):

Nerve Repair ◽

Donor Site ◽

Digital Nerve ◽

Great Toe ◽

Dorsal Branch ◽

Mean Size ◽

The Mean ◽

Repair Group ◽

Composite Flap

We describe reconstruction of a nail unit defect in the finger using a free composite flap taken from the great toe, comparing the outcome in patients in whom neurorrhaphy between the dorsal digital nerve of the great toe and the dorsal branch of the proper digital nerve of the injured finger was performed to those in which no nerve repair was made. From January 2002 to March 2009, 47 patients with traumatic fingernail defects were treated. Twenty-two patients before February 2005 had no nerve repair and subsequently 25 patients had nerve repair. The mean size of the germinal matrix and sterile matrix defects was 9 × 8 mm, and the mean size of the nail bed flaps was 9 × 9 mm. The mean length of the arteries used for the flap was 2.2 cm. Outcomes were rated. In the nerve repair group, full flap survival was achieved in 24 patients. At the mean follow-up period of 25 months, there were 12 excellent, seven very good, four good, and two fair results. In the comparison group without nerve repair, there were seven excellent, four very good, four good, five fair, and two poor results. Donor site morbidities were similar in both groups. The use of a free composite flap taken from the great toe is a useful technique for reconstructing nail unit defects in the finger. Innervated nail flap reconstructions tended to show better outcomes than those in which no nerve repair was performed. There is no difference in function or donor site between those in whom the nerve was repaired compared with those in whom it was not repaired.

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The retrograde neurocutaneous island flap of the dorsal branch of the ulnar nerve: anatomical basis and clinical application

Surgical and Radiologic Anatomy ◽

10.1007/s00276-003-0174-2 ◽

2004 ◽

Vol 26 (1) ◽

pp. 8-13 ◽

Cited By ~ 15

Author(s):

V. Casoli ◽

P. V�rolino ◽

P. P�lissier ◽

E. Kostopoulos ◽

P. Caix ◽

...

Keyword(s):

Ulnar Nerve ◽

Clinical Application ◽

Island Flap ◽

Anatomical Basis ◽

Dorsal Branch

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First dorsal metacarpal artery flap with dorsal digital nerve with or without dorsal branch of the proper digital nerve produces comparable short-term sensory outcomes

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02838-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Shi-Ming Feng ◽

Jia-Ju Zhao ◽

Filippo Migliorini ◽

Nicola Maffulli ◽

Wei Xu

Keyword(s):

Patient Satisfaction ◽

Digital Nerve ◽

Reconstruction Procedure ◽

Level Of Evidence ◽

Cold Intolerance ◽

Dorsal Branch ◽

Dorsal Metacarpal Artery ◽

Retrospective Comparative Study ◽

First Dorsal Metacarpal Artery

Abstract Background The first dorsal metacarpal artery flap, including dorsal digital nerves with or without dorsal branches of the proper digital nerves, can be used to reconstruct thumb pulp defects with good results. However, it is still unclear whether there are differences in the sensory outcomes between preserving or not preserving the dorsal branches of the proper digital nerves. Methods This retrospective cohort study included 137 thumb pulp defect patients who underwent first dorsal metacarpal artery flap reconstruction procedure from October 2015 to June 2019. Patients were divided into two groups according to whether the dorsal branches of the proper digital nerves were preserved. In the non-preservation group (n = 80), the dorsal digital nerves were included in the flap for sensory reconstruction. In the preservation group (n = 57), the dorsal digital nerves and the dorsal branches of the proper digital nerves of the index finger were included in the flap. The stump of the proper digital nerves in the defect was coaptated to the donor nerves of the flap using the end-to-end fashion. At the last follow-up, static two-point discrimination, Semmes–Weinstein monofilament scores, pain, cold intolerance of the reconstructed finger, and patient satisfaction in both groups were compared. Results All patients were followed up for at least 17 months. No significant differences were found regarding pain of thumb pulp, static two-point discrimination, Semmes–Weinstein monofilament score, cold intolerance in the injured finger, and patient satisfaction. The non-preservation group presented slightly shorter operative times (p < 0.05). Conclusion There are no differences at 2 years in postoperative clinical outcomes when dorsal digital nerves are used to reconstruct flap sensation regardless of preservation of the dorsal branches of the proper digital nerves in the first dorsal metacarpal artery flap. Level of evidence: Level III, retrospective comparative study.

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Sensate Neurovascular Island Flap for Thumb Reconstruction

Journal of Wound Management and Research ◽

10.22467/jwmr.2020.01326 ◽

2021 ◽

Vol 17 (1) ◽

pp. 48-52

Author(s):

Sungmi Jeon ◽

Seung Min Kim ◽

Sung Tack Kwon

Keyword(s):

Postoperative Complications ◽

Middle Finger ◽

Venous Congestion ◽

Island Flap ◽

Middle Phalanx ◽

Digital Nerve ◽

Thumb Reconstruction ◽

Ulnar Side ◽

Aesthetic Appearance ◽

Neuroma Formation

Thumb pulp defects require adequate reconstruction for satisfactory sensate function and aesthetic appearance. We report a reconstructive case using a sensate neurovascular island flap raised from the ulnar side of the middle finger for a tactile thumb pad defect. The flap was elevated as a modified version of the conventional heterodigital neurovascular island flap in order to restore thumb sensation without the “double-sensibility” phenomenon. The ulnar digital nerve of the flap was sectioned at the middle phalanx level of the donor digit and coaptated to the ulnar and radial digital nerves of the thumb through end-to-side and end-to-end neurorrhaphy. The remaining radial digital nerve of the donor finger was preserved, and the proximal end of the sectioned nerve was coaptated end-to-side to the radial digital nerve to prevent neuroma formation. No postoperative complications including venous congestion were observed. This technique is a relatively simple and reliable option for reconstructing thump pulp defects.

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