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

2014 ◽  
Vol 133 (2) ◽  
pp. 165e-173e ◽  
Author(s):  
Chao Chen ◽  
Peifu Tang ◽  
Xu Zhang
Keyword(s):  
Island Flap ◽  
Digital Nerve ◽  
Dorsal Branch

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

2019 ◽  
Vol 6 (1) ◽  
pp. 74-78
Author(s):  
Takeo Osaki ◽  
Tadashi Nomura ◽  
Kazunobu Hashikawa ◽  
Hiroto Terashi
Keyword(s):  
Island Flap ◽  
Vascular Pedicle ◽  
Digital Nerve ◽  
Dorsal Branch

Modified Littler flap for sensory reconstruction of large thumb pulp defects

2018 ◽  
Vol 43 (5) ◽  
pp. 546-553 ◽  
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

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

2015 ◽  
Vol 41 (2) ◽  
pp. 177-184 ◽  
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

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

2014 ◽  
Vol 40 (6) ◽  
pp. 583-590 ◽  
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.

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

2004 ◽  
Vol 26 (1) ◽  
pp. 8-13 ◽  
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

scholarly journals 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

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.

scholarly journals Sensate Neurovascular Island Flap for Thumb Reconstruction

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.

Treatment of a Combination of Volar Soft Tissue and Proper Digital Nerve Defects Using the Dorsal Digital Nerve Island Flap

2010 ◽  
Vol 35 (10) ◽  
pp. 1655-1662.e3 ◽  
Author(s):  
Chao Chen ◽  
Xu Zhang ◽  
Xinzhong Shao ◽  
Shunhong Gao ◽  
Bin Wang ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Island Flap ◽  
Digital Nerve

scholarly journals The Clinical Effect of Digital Dorsal Fascial Island Flap Combined With Crossfinger Flap for Repairing Distal Degloving Injury and Sensory Reconstruction

2022 ◽  
Vol 8 ◽  
Author(s):  
Ruizheng Hao ◽  
Yongxin Huo ◽  
Hui Wang ◽  
Wei Liu
Keyword(s):  
Clinical Effect ◽  
Distal Segment ◽  
Soft Tissue Defect ◽  
Island Flap ◽  
Large Area ◽  
Degloving Injury ◽  
Dorsal Branch ◽  
Branch Vessel ◽  
Degloving Injuries ◽  
Sensory Reconstruction

BackgroundTo explore the clinical effect of digital dorsal fascial island flap combined with crossfinger flap to repair distal degloving injury and sensory reconstruction.MethodsA total of 19 patients with distal fingertip degloving injuries treated with digital dorsal fascial island flap combined with crossfinger flap in our hospital from April 2018 to August 2020 were retrospectively included. Semmes–Weinstein (SW) monofilament and static two-point discrimination (S-2PD) tests, active range-of-motion (ROM) of the fingers, cold intolerance, visual analog scale (VAS) score patient complications, and patient satisfaction were evaluated.ResultsFive cases with post-operative flap blisters were treated at the time of dressing changes until successful scab formation. Three cases with post-operative arterial crisis of finger arterial dorsal branch vessel were relieved after suture removal and tension reduction. All other skin flaps and skin grafts survived. Nineteen patients received follow-up between 3 and 26 months (average 14.6 months). The active ROM of metacarpophalangeal (MCP) and interphalangeal (IP) joints of the injured fingers were satisfactory.ConclusionThe digital dorsal fascial island flap combined with the crossfinger flap for repairing the distal degloving injury of the distal segment of the finger is a good surgical method, which is simple and easy to operate, can repair a large area of soft tissue defect, and obtain a satisfactory effect.

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