41 heterodigital neurovascular island flaps were used to cover defects of the tactile pad of the thumb in 17 years. With an average follow-up of 75.5 months, 30 patients were reviewed. 17 were treated by the original Littler technique and 13 were treated with the same flap reconstruction but with division of the digital nerve innervating the flap and re-anastomosis of this nerve to the proximal nerve end of the ulnar digital nerve of the thumb. Good aesthetic and functional results were achieved in both groups. Sensory acuity did not appear to decrease with time. The nerve reconnection technique solves the "double sensibility" phenomenon (present in 41.1% of our cases treated by the original technique), but two-point discrimination is less than that achieved by the Littler technique. Most complaints were related to the donor site such as hypertrophic scarring or scar contracture and cold intolerance, but these did not cause any real functional impairment.

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The authors report nine cases of hetero-digital neurovascular island flaps raised by the "disconnecting-reconnecting" technique for defects of the tactile pad of the thumb. At an average follow-up of 25 months, all cases had good restoration of sensibility without any "double sensibility" phenomenon and patients regained good dexterity. No tender neuromata developed and donor site complications were not troublesome.

The purpose of this paper was to present a case of an occult lung cancer diagnosed by the presenceof a carpal bone metastatic lesion.

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