title: Reconstruction of a neurocutaneous defect of the proximal phalanx with a heterodigital arterialised nerve pedicle flap.
abstract: BACKGROUND
  Complex digital injuries involving soft-tissue loss and digital nerve defect pose a challenging problem for hand surgeons. The purpose of this study was to evaluate the efficacy of transferring the heterodigital arterialised nerve pedicle flap for reconstructing the digital neurocutaneous defects and to compare the results with those of transferring the cross-finger flap and secondary nerve grafting.
  
  
  METHODS
  From March 2008 to September 2011, the nerve pedicle flap was used in 12 patients who had a combination of soft-tissue and digital nerve defects. The injured fingers included four index, four long, three ring and one little finger. The mean size of the soft-tissue losses was 2.4×1.9 cm (range, 2.3×1.3 to 3.2×2.0 cm). The mean flap size was 2.6×2.1 cm (range, 2.5×1.5 to 3.4×2.2 cm). The length of the nerve defects ranged from 1.5 to 3.8 cm (mean, 2.8 cm). The nerve defect was reconstructed with transfer of the digital nerve dorsal branch. For comparison, we collected a series of 24 patients with similar defects treated with the cross-finger flap and secondary free nerve grafting.
  
  
  RESULTS
  Significant differences were found between the two groups in static two-point discrimination (p<.01) and pain (p=.03) in the reconstructed finger. In comparison, the study group presented better discriminatory sensation on the finger pulp and lower incidence of pain sensibility in the injured finger. There was no significant difference in cold intolerance and Semmes-Weinstein monofilament. In the study group, the total active motion of the donor fingers was similar to that of the opposite hands.
  
  
  CONCLUSIONS
  The heterodigital arterialised nerve pedicle flap is useful and reliable for reconstructing the neurocutaneous defects in the proximal phalanx. Comparable sensory recovery and lower pain incidence can be achieved using our nerve pedicle flap instead of conventional nerve grafting.
  
  
  METHODS
  Therapeutic II.
authors.affiliation: The Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, PR China. Electronic address: ts_chenchao@163.com.
authors.forename: Chao
authors.initials: C
authors.lastname: Chen
authors.affiliation: The Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, PR China. Electronic address: tangpeifubeijing@163.com.
authors.forename: Peifu
authors.initials: P
authors.lastname: Tang
authors.affiliation: Hand Surgery Department, The Second Hospital of Qinhuangdao, Changli, Qinhuangdao, Hebei, 066600, PR China; Chengde Medical College, Chengde, Hebei, 067000, PR China.
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000328:Adult; D005260:Female; D005383:Finger Injuries / Q000503:physiopathology / Q000601:surgery*; D005385:Fingers / Q000294:innervation / Q000601:surgery*; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D010525:Peripheral Nerves / Q000503:physiopathology / Q000601:surgery*; D019651:Plastic Surgery Procedures; D020127:Recovery of Function; D012677:Sensation; D017695:Soft Tissue Injuries / Q000503:physiopathology / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome
keywords: Dorsal branch of the digital nerve; Heterodigital arterialised island flap; Nerve defect; Nerve transfer; Soft-tissue loss