Repair of Finger Pulp Defect and Sensory Reconstruction Using Reverse Homodigital Artery Island Flap With Palmar Cutaneous Branches of the Proper Digital Nerve

Abstract

ObjectiveTo illustrate the clinical outcomes of the reverse digital proper artery island flap with anastomosing the palmar cutaneous branches of the proper digital nerve for the reconstruction of finger pulp defects.MethodsFrom December 2007 to December 2017, a total of 20 patients with finger pulp defects were treated with reverse digital proper artery island flap for innervated construction. Functional outcomes, aesthetic appearance, and complications were evaluated. Functional outcomes were assessed according to range of motion, sensory grade (S0–S4), static 2-point discrimination, Semmes-Weinstein monofilament test, and Cold Intolerance Severity Score. Aesthetic appearance was evaluated according to the Michigan Hand Outcomes Questionnaire.ResultsAll flaps survived completely without any complications, and all patients were followed up for at least 12 months. The average static 2-point discrimination, Semmes-Weinstein monofilament, and Cold Intolerance Severity Score results of the injured fingers were 6.35 mm (range, 5–8 mm), 3.64 (range, 2.83–4.17), and 19 (range, 8–24), respectively. All patients achieved recovery in sensation from S3+ to S4. The active ranges of motion of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of the affected fingers were satisfactory. Based on the Michigan Hand Outcomes Questionnaire, 11 patients were strongly satisfied, and 9 were satisfied with the appearance of the injured finger.ConclusionsThe reverse digital proper artery island flap with anastomosing the palmar cutaneous branches of the proper digital nerve is an effective and reliable alternative for the reconstruction of finger pulp defect. In the recovery of sensation, this flap leads to satisfactory effects.

Advancing Fingertip Regeneration: Outcomes from a New Conservative Treatment Protocol

“…First, the absence of a surgical control group may affect the generalizability of the findings. This decision was guided by multiple factors: the inherent drawbacks of surgical interventions [6][7][8]10,13,33], encouraging outcomes from conservative approaches in prior studies [12,14,16,17,[21][22][23][24][34][35][36], and significant recruitment challenges due to patients' strong preference for less invasive treatments [37]. Moreover, based on the author's experience, the toe pulp free flap was identified as the most comparable surgical technique to the proposed conservative treatment.…”

“…Traditionally, surgical approaches, such as local flaps, skin grafts, and free tissue transfers, have been employed to manage fingertip injuries with volar pulp defects [3,[5][6][7][8][9]. While these techniques aim to restore the soft tissue envelope and preserve finger length, they are often associated with donor site morbidity, prolonged immobilization, and the need for multiple surgeries [3,4,10].…”

Reverse Homodigital Artery Island Flap With Palmar Cutaneous Branches of the Proper Digital Nerve for Repairing of Finger Pulp Defect and Sensory Reconstruction: Is It Deserving?

“…We read with great interest the recent original article by Wang et al, 1 “Repair of Finger Pulp Defect and Sensory Reconstruction Using Reverse Homodigital Artery Island Flap With Palmar Cutaneous Branches of the Proper Digital Nerve,” published in the Annals of Plastic Surgery . In this study, the authors introduced a reverse digital proper artery island flap with anastomosing the palmar cutaneous branches of the proper digital nerve for the reconstruction of finger pulp defect.…”