Resurfacing of thumb-pulp loss with a heterodigital neurovascular island flap using a nerve disconnection/reconnection technique.
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.
Kumta
S M
SM
Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong.
Yip
K M
KM
Pannozzo
A
A
Fong
S L
SL
Leung
P C
PC
D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D013524:Surgical Flaps / Q000379:methods*; D013933:Thumb / Q000294:innervation* / Q000601:surgery*; D014110:Touch