Evaluation of moving and static two point discriminations of volar forearm skin before and after transfer as a sensate radial forearm island flap in reconstruction of degloving injury of the thumb

Comparing Innervated and Noninnervated Glabrous Skin Flaps for Volar Digital Defects: Insights from Patient-Reported Outcomes

BACKGROUND

Volar soft-tissue defects in digits necessitate reconstructions that restore appearance sensation and minimize complications. This study compared innervated toe pulp (TP) and noninnervated medialis pedis (MP) flaps for reconstructing such defects, focusing on objective and subjective outcomes.

METHODS

Between 1998 and 2017, 101 free glabrous skin flap reconstructions were performed at the authors' institution for volar digital soft-tissue injuries, comprising 75 TP flaps and 26 MP flaps. Follow-up assessments included the Michigan Hand Outcomes Questionnaire; Disabilities of the Arm, Shoulder and Hand Questionnaire; Foot and Ankle Disability Index; and sensory testing (static and moving two-point discrimination, Semmes-Weinstein monofilament test). Data analysis used the Mann-Whitney U test and Pearson correlation coefficients.

RESULTS

The study cohort included 29 participants (TP, n = 15; MP, n = 14) with an average follow-up of 106 months. Functional and sensory outcomes revealed no significant differences between TP flaps and MP flaps. Both flap types achieved satisfactory function and sensibility, with no statistically significant distinctions in patient-reported outcomes. Subjective complaints were similarly distributed across both groups, with a few reports of cold intolerance and discomfort at the donor site in the TP flap group.

CONCLUSIONS

TP and MP flaps provide adequate coverage and sensory outcomes for volar digital defects without significant differences between innervated and noninnervated flap transfers. The flap choice should be tailored to individual patient needs and defect characteristics, emphasizing the importance of patient-centered decision-making in reconstructive surgery. Further research is required to explore the long-term outcomes of these reconstruction methods, especially for larger defects.

End-to-side innervated sensate radial forearm flap in the hand: A 5-year follow-up

Optimal functional reconstruction of the palmar surface of the hand requires good sensibility especially for the thumb and the radial side of the fingers. We report the long-term results of a distally based radial forearm flap (RFF) used for soft tissue coverage in the palm, index and middle finger and an end-to-side neurorrhaphy between the lateral antebrachial cutaneous nerve (LACN) and the proper palmar digital nerve of the middle finger to restore sensation. At 5 years' follow-up, the patient's sensory recovery was assessed through static and moving two-point discrimination, light touch sensation, pain perception, hot and cold temperature perception, an electrophysiological study and sweat test. An S3+ sensory recovery on the British Medical Research Council scale, as modified by Mackinnon and Dellon, was noted together with a good perception in the palm compared to decreased perception in the volar surface of the proximal phalanx. These findings prove that the RFF can provide good functional coverage of the palm together with good sensitivity by end-to-side reinnervation.

Treatment of fingertip avulsion injuries using two periposition pedicled flaps

We described a treatment of fingertip avulsion injury by two periposition pedicled flaps, the reversed pedicle island flap of dorsal branch of proper digital artery and the cross-finger flap. From February 2009 to January 2017, 22 patients (22 fingers) with fingertip avulsion injury were treated with two periposition pedicled flaps, 14 male and 8 female, aged from 17 to 47 years (mean 32 ± 9 years). All of the patients were followed up more than 6 months after operations (mean 9.6 ± 2.6 months). All flaps survived completely. Compared with the traditional abdominal flaps, two periposition pedicled flaps had less pedicle division time. At last follow-up, the 2PD of the palmar part of the flaps, the TAM of the injured finger and the MHQ summary score of the two periposition pedicled flaps were much better than the traditional abdominal flaps. The reconstruction using two periposition pedicled flaps is a versatile treatment with better functions, less morbidity and better aesthetics. Level of evidence: Therapeutic, level III.

Sensory reinnervation of free flaps in reconstruction of the breast and the upper and lower extremities

There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves “untreated”. Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.