Innervated Reverse Digital Artery Island Flap through Bilateral Neurorrhaphy using Direct Small Branches of the Proper Digital Nerve.
BACKGROUND
The reverse digital artery flap uses the radial or ulnar surface of the proximal phalanx of the involved digit and has been applied to sensate flaps using the superficial sensory nerve branch and the dorsal branch of the proper digital nerve. As these nerve branches innervate the dorsal surface of the finger, however, hypesthesia of the dorsal side of the middle phalanx is inevitable.


METHODS
Thirty fingers of 25 patients who had the innervated reverse digital artery flap using direct small branches of the proper digital nerve were included in this study. The minimum follow-up duration was 24 months, and the average defect size was 2.8 cm(2).


RESULTS
In all cases, the pulp defects were successfully reconstructed with this flap. The average size of the donor flap was 3.9 cm(2). At 6 months after surgery, the average static two-point discrimination value was 5.9 mm, the average moving two-point discrimination value was 5.0 mm, and the average Semmes-Weinstein monofilament score was 3.79. At 1 year postoperatively, the average Cold Intolerance Severity Score was 20. The percentage total active motion was measured at 99 percent 2 years after surgery.


CONCLUSIONS
Because this flap does not sacrifice the proper digital nerve or dorsal branch of the nerve, the sensibility of the dorsal aspect of the proximal and middle phalanx can be preserved. This flap is cosmetically excellent, as it uses a donor flap similar to the injured fingertip and the donor scar can be hidden by adjacent fingers.


METHODS
Therapeutic, IV.
Seoul, South Korea From the Department of Orthopedic Surgery, Seoul National University College of Medicine.
Jihyeung
J
Kim
Young Ho
YH
Lee
Min Bom
MB
Kim
Seung Hoo
SH
Lee
Goo Hyun
GH
Baek
D000328:Adult; D001158:Arteries / Q000601:surgery; D005260:Female; D005383:Finger Injuries / Q000175:diagnosis / Q000601:surgery*; D005385:Fingers / Q000294:innervation; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010525:Peripheral Nerves / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply* / Q000294:innervation*; D013997:Time Factors; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult