title: The spiral flap for fingertip resurfacing: short-term and long-term results.
abstract: OBJECTIVE
  We describe a homodigital neurovascular island flap for reconstructing large pulp defects of the fingertips and review the short-term and long-term appearance and function of the reconstructed fingertips.
  
  
  METHODS
  The spiral flap is a homodigital neurovascular island flap with a unique spiral advancement and transposition design that allows pulp reconstruction using sensate glabrous skin while restricting donor morbidity to the injured digit. Thirty-two fingertips were resurfaced using this flap. All had large pulp defects averaging 1.2 cm wide x 2.0 cm long (1.0-2.0 cm x 1.5-2.5 cm). Short-term results (<18 months) for all patients at a minimum of 6 months and long-term results (>5 years) for 10 patients with a mean follow-up of 13 years were reviewed. Objective outcome measures included static 2-point discrimination, degree of nail deformity (beaking), total active motion, and hypersensitivity or cold intolerance. Subjective outcome measures included patient satisfaction with function and aesthetics, using a visual analog scale.
  
  
  RESULTS
  All flaps achieved primary healing with no complications. There was initially mild extension deficit in the proximal interphalangeal and distal interphalangeal joints, which improved to full range of motion in the long term. Sensory recovery was excellent, with an average 2-point discrimination of 5 mm initially, improving to 4 mm in the long term. Nail beaking was minimal initially but increased significantly in the long term. These results may be explained by soft tissue remodeling. All patients on long-term follow-up were highly satisfied with both aesthetic and functional outcome. There was no hypersensitivity or cold intolerance at either the short-term or long-term follow-up assessments.
  
  
  CONCLUSIONS
  The spiral advancement-transposition flap is suitable for resurfacing large pulp defects with excellent short-term and long-term functional and aesthetic results and high patient satisfaction.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Hand Surgery, Singapore General Hospital, Singapore.
authors.forename: Gale J S
authors.initials: GJ
authors.lastname: Lim
authors.forename: Andrew K T
authors.initials: AK
authors.lastname: Yam
authors.forename: Jonathan Y L
authors.initials: JY
authors.lastname: Lee
authors.forename: Teoh
authors.initials: T
authors.lastname: Lam-Chuan
mesh_terms: D000293:Adolescent; D000328:Adult; D004954:Esthetics; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009264:Nails, Malformed / Q000145:classification / Q000209:etiology; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012677:Sensation; D013524:Surgical Flaps / Q000009:adverse effects / Q000294:innervation; D016896:Treatment Outcome