Coverage of fingertip defect using a dorsal island pedicle flap including both dorsal digital nerves.
OBJECTIVE
Fingertip or pulp resurfacing is a challenging reconstructive problem, as the treatment varies widely. In this study, we report the results of a dorsal island pedicle flap raised from an adjacent finger, including the bilateral dorsal digital nerves, for coverage of extensive soft tissue defect in the fingertip or pulp.


METHODS
The mean defect and the flap were 3.7 x 2.2 cm and 3.9 x 2.4 cm in size, respectively. In all cases, bilateral coaptation between the dorsal digital nerves and the proper digital nerves were performed. Patient follow-up lasted 25 to 34 months (mean, 27 months). The range of motion of the injured digits was measured. Sensibility of both radial and ulnar sides of the flap in the finger pulp was evaluated by the Semmes-Weinstein monofilament test and 2-point discrimination. Satisfaction with the appearance, pain, and cold intolerance were also assessed.


RESULTS
All flaps survived completely with maintenance of the normal-length digit. Full motion was maintained at the distal and proximal interphalangeal joints of both the injured and donor fingers. The mean values of Semmes-Weinstein sensitivity were 4.22 g and 4.31 g on the radial and ulnar sides of the flap in the pulp, respectively. The mean values of static 2-point discrimination were 4.4 mm and 4.5 mm on the radial and ulnar sides, respectively. All patients were satisfied with appearance of the fingertips.


CONCLUSIONS
The dorsal island pedicle flap from an adjacent finger can be used for coverage of extensive fingertip or pulp defects, with maintenance of a normal-length digit and restoration of sensation on both the radial and ulnar sides of the finger pulp. The sensation recovery of this series is superior to those dorsal island pedicle flaps previously described in the literature, which did not include incorporation of both dorsal digital nerves.


METHODS
Therapeutic IV.
Shao
Xinzhong
X
Hand Surgery Department, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China. shaoxinzhong@sina.com
Chen
Chao
C
Zhang
Xu
X
Yu
Yadong
Y
Ren
Dongliang
D
Lu
Li
L
D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D004954:Esthetics; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D017288:Pain Threshold / Q000502:physiology; D017060:Patient Satisfaction; D011182:Postoperative Care; D011183:Postoperative Complications / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000502:physiology; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply / Q000294:innervation*; D013823:Thermoreceptors / Q000502:physiology; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult