Long-term outcomes of homodigital neurovascular island flap reconstruction of fingertip injuries in children

Abstract

We evaluated the long-term functional and cosmetic results of homodigital neurovascular island flap (NIF) used to reconstruct extensive pulp defects with bone exposure in children. Twenty-three children (mean age 4.8 years, range 1–10 years) with fingertip injuries were reconstructed with a pedicled homodigital NIF and evaluated in terms of sensation quality, cold intolerance, scar formation, nail deformity, range of motion and overall finger length at a mean follow up of 7.8 years (range 2–13). Eleven patients reported cold sensitivity in the operated fingertip, and 15 presented with hook nail deformities at the final follow-up. The total active motion of the injured finger was significantly lower than that of the uninjured side ( p < 0.001). NIFs is a safe, reliable reconstructive treatment for fingertip loss in children, but commonly encountered issues in the long term include an extension lag of the interphalangeal joints, hook nail deformities and cold intolerance. Level of evidence: IV

Homodigital Unipedicled Islanded Neurovascular Pulp Advancement Flap/Colombo Flap for Fingertip Reconstruction: A Case Series with a Novel Technique

“…Biddulph's modifications of the Kutler and Venkataswami flaps are examples for these flaps and they also reported better outcomes in the literature. 6 7 8 9 However, we observe that these techniques leave a scar across the volar side of the distal phalanx or across the DIPJ crease, which could lead to low patient satisfaction. Mourougayan and Venkat 10 described a modification of the Atasoy flap to address this issue, but it requires dissection of both neurovascular pedicles.…”

Reconstruction of a Pediatric Distal Phalanx Amputation With Stacked Integra Dermal Substitute: A Case Report

“…Regardless of the mechanism, the goal after any finger amputation is to preserve as much bone and finger length as possible, minimize the risk of infection, have a durable soft tissue envelope, and maximize function. Several soft-tissue reconstruction techniques are effective for fingertips including V-Y advancement flaps [4,9], cross-finger flaps [9,10], thenar flaps [11], and homodigital neurovascular island flaps [12].…”