Modified Heterodigital Neurovascular Island Flap for Sensory Reconstruction of Pulp or Volar Soft Tissue Defect of Digits

PURPOSE

We report the efficacy of a modified heterodigital neurovascular island flap innervated by the dorsal branch of the proper digital nerve and the proper digital nerve, for repairing either pulp or volar defects in the fingers.

METHOD

We repaired 14 digits of 14 patients who had a complex defect involving soft tissue and digital nerve in the pulp or volar surface of the digit using the modified heterodigital neurovascular island flap. Cases were divided into 2 groups: a pulp defect group including 5 thumbs and 1 little finger; and a volar defect group with a digital nerve defect, involving one thumb, 3 index and 3 middle fingers, and one ring finger. At the recipient site, nerve stumps of the PDNs in the pulp defect group were coapted with the proximal ends of the dorsal branch of the PDN and the proper digital nerve in the flap. The distal and proximal ends of the PDN in the flap were intercalated into the defect of the PDN in volar defect group, and the proximal end of dorsal branch of PDN in the flap was also coapted to the proximal end of the proper digital nerve of the recipient finger. At the donor site, the defect of the proper digital nerve was repaired with nerve graft harvested from the proximal portion of the dorsal branch of the same proper digital nerve, and a full-thickness skin graft covered the donor site.

RESULTS

All flaps and the skin grafts of the donor site survived completely. At the final follow-up, 9 of 14 flaps had a static 2-point discrimination result below the normal threshold (< 6 mm).

CONCLUSIONS

The modified heterodigital neurovascular island flap is a useful and reliable treatment option for a digital pulp or volar defect, especially when the digital nerve defect requires repair.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.