Resurfacing of Thumb‐pulp Loss with a Heterodigital Neurovascular Island Flap Using a Nerve Disconnection/Reconnection Technique

Abstract

The problems of late deterioration of sensation and a "double sensibility" phenomenon, either in the thumb or donor finger, are a known deficiency of the conventional heterodigital neurovascular island flap. This is probably related to unsatisfactory cortical reorientation following flap transfer. To obviate this problem, the authors have used a disconnection/reconnection technique for heterodigital island flaps in 17 patients, to resurface defects in the skin of the thumb. All patients were followed-up for 1 year, while 15 were followed-up for 2 years or more. There were no flap complications or failures, and the length of the thumb tip was preserved in all cases. The classic two-point discrimination was less than 6 mm in eight of these patients, and the remaining nine patients had two-point discrimination of between 6 and 8 mm. This technique was found to provide sensitive, supple, and well-vascularized skin with proper cortical representation, to replace the loss of the tactile pump of the thumb tip in one operative stage.

Extending the Reach of the Heterodigital Arterialized Flap by Vein Division and Repair

“…During the dissection and mobilization of the arterial pedicle, the digital artery to the adjoining finger would have to be ligated and divided. 8,9,11 Before this is done, it is prudent to check again, with a microclip, the adequacy of the other digital artery. The transverse palmar arches of the artery 12 will be encountered during the dissection of the arterial pedicle.…”