Thumb Tip Defect Reconstruction Using Neurovascular Island Pedicle Flap Obtained From Long Finger

Abstract

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Reconstruction of extensive pulp defects of the thumb with a radial-based pedicled flap from the index finger

“…Our flap reached a mean static 2PD of 7.2 mm, which is rated as good according to the Modified American Society for Surgery of the Hand Guidelines for Stratification of 2PD (Dellon and Kallman, 1983). This result is better than the above-mentioned options and similar to the reported outcomes of the Littler neurovascular island flap in the reconstruction of thumb pulp defects with a mean 2PD score of 7.3 (Xarchas et al., 2008), although innervated heterodigital flaps for thumb tip reconstruction may demonstrate mean static 2PD values as low as 5.3 mm (Liu et al., 2016). Nerve coaptation may be regarded as a disadvantage compared with intact neurovascular pedicled flaps.…”

Sensate Neurovascular Island Flap for Thumb Reconstruction

“…A cuff of the fibro-fatty tissue surrounding the neurovascular bundle should be incorporated for venous drainage. Venous congestion of the flap is a potential problem in the early postoperative period, but it does not compromise the overall flap viability [1,7]. In our case, PDN of the flap was cut to a minimal length that allowed tension-free neurorrhaphy to PDN of the thumb (Figs.…”

“…The thumb pulp is critical for the pinch maneuver; when it is damaged, neurovascular flaps are preferred for their sensory reconstruction. Homodigital or heterodigital neurovascular island pedicle flaps provide a one-stage method for sensory reconstruction for the thumb pulp [1]. The Littler flap has the advantages of needing only a single operative field with shorter operation time.…”

“…The treatment choice is usually guided by the level and extent of the injury. In wounds with exposed bone or tendon, flap reconstructions, instead of secondary healing or skin grafting, are usually the procedure of choice [1].…”

“…Recently, new techniques, including toeto-thumb and wrap-around flap, have been widely applied. However, the free microvascular flaps are sometimes limited in application because of the extended operation time, greater skill requirements, and donor site morbidity [1].…”