title: The outcome of direct-flow neurovascular island flaps in pulp defects.
abstract: OBJECTIVE
  In this study we aimed to evaluate the results of the direct-flow neurovascular island flap (NIF) transfers in pulp defects.
  
  
  METHODS
  We reviewed the records of 96 patients with 115 NIF transfers performed for pulp defect reconstruction. The injury mechanism was crush type injury in 70 patients (72.9%). Ninety-three patients (97%) were emergency cases. Pulp reconstruction was performed by means of pedicled island flap transfer. The results were evaluated with proximal interphalangeal joint range of motion, the Semmes Weinstein monofilament test, static two-point discrimination and cold intolerance assessments. The relations between the injury mechanism, patient satisfaction, cold intolerance and scar problems were analyzed. Also, the association between skin grafting and hook nail deformity was investigated. The level of significance was set at p<0.05.
  
  
  RESULTS
  All flaps survived. The mean follow-up time was 41±20.3 (range: 12-108) months. We observed proximal interphalangeal joint flexion contracture in 11 (9.5%) cases. In seven of these, the limitation was less than 10 degrees. Hook nail deformity was seen in 8 fingers (7%). Cold intolerance was found in 16 (17%) cases. Semmes Weinstein monofilament and static-two point discrimination tests of flaps revealed satisfactory results. There was no relation between the injury mechanism and cold intolerance, patient satisfaction and scar problems (p>0.05). Among patients, 91.7% were satisfied with their results.
  
  
  CONCLUSIONS
  The transfer of direct-flow island flaps, from the same finger, causes minimal morbidity on the donor site and appears to be a safe method, providing satisfactory functional and aesthetic results in the reconstruction of pulp defects.
authors.affiliation: Hand and Microsurgery Hospital, İzmir, Turkey. elmikro2003@yahoo.com
authors.forename: Murat
authors.initials: M
authors.lastname: Kayalar
authors.forename: Emin
authors.initials: E
authors.lastname: Bal
authors.forename: Tulgar
authors.initials: T
authors.lastname: Toros
authors.forename: S Tahir
authors.initials: ST
authors.lastname: Süğün
authors.forename: Kemal
authors.initials: K
authors.lastname: Özaksar
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Gürbüz
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005383:Finger Injuries / Q000145:classification / Q000503:physiopathology / Q000601:surgery; D005384:Finger Joint / Q000098:blood supply / Q000294:innervation / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D059348:Peripheral Nerve Injuries / Q000209:etiology* / Q000517:prevention & control; D010525:Peripheral Nerves; D011183:Postoperative Complications / Q000517:prevention & control*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012039:Regional Blood Flow; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply / Q000294:innervation; D015599:Trauma Severity Indices; D016896:Treatment Outcome