Comparative Study of the Clinical Effects of Reverse Digital Artery Island Flaps and Antegrade Homodigital Neurovascular Island Flaps for Fingertip Reconstruction

Abstract

Objective: This retrospective study aimed to compare the clinical effects of reverse digital artery island flaps and antegrade homodigital neurovascular island flaps in fingertip reconstruction. Patients and Methods: We retrospectively analyzed the data of 30 consecutive patients with fingertip defects who had undergone 2 types of surgery from January 2016 to January 2019. We used reverse digital artery island flaps and antegrade homodigital neurovascular island flaps in 14 and 16 patients, respectively. Flap sensitivity was evaluated using the Semmes-Weinstein monofilament test and static 2-point discrimination test. Finger appearance was assessed using the Michigan Hand Outcomes Questionnaire. The operation time, flap sensitivity, range of motion of the interphalangeal joint, and complications were evaluated. Results: The static 2-point discrimination results of the fingers were significantly different between the antegrade homodigital neurovascular island flap group and reverse digital artery island flap group (8.07 ± 1.54 vs 5.94 ± 1.73; P < 0.05). The appearance of the fingers was significantly better in the antegrade homodigital neurovascular island flap group. Surgery using antegrade homodigital neurovascular island flaps required less time than surgery using reverse digital artery island flaps. No significant differences were found between the 2 groups in the range of motion of the interphalangeal joint or complications. Conclusions: The functional outcomes were identical between the reverse digital artery island flap and antegrade homodigital neurovascular island flap methods for fingertip reconstruction. Antegrade homodigital neurovascular island flaps lead to a shorter operation time, a more satisfying appearance, and better sensory recovery.

Repair of Finger Pulp Defect and Sensory Reconstruction Using Reverse Homodigital Artery Island Flap With Palmar Cutaneous Branches of the Proper Digital Nerve

“…Flap based on dorsal branches of the proper digital artery is one of the most popular options for repair of finger pulp defects 26,27 . The flap requires sacrificing a digital artery 4 . Cold intolerance can occur when the flap sacrifices a digital artery in the injured finger.…”

“…In addition, the abrasion resistance of the skin piece is poor, and the method is not suitable for fingers with bone or tendon exposure. 4 The cross-finger flap can be used to cover the defects and has the advantages of anatomical constancy, little variation, satisfactory appearance, and ideal results after repair. However, it brings about damage to the adjacent finger, which destroys the integrity of the healthy finger.…”

“…The main function of fingertip is to grasp and pinch objects with quintessential sensation and resist to mechanical forces 1 . Finger pulp defect is a common type of hand injury, which often requires a flap for repair 2–4 . For factory workers, they often suffer from cutting injuries, stamping injuries, and mechanical strangulation injuries that can lead to the exposure of major structures such as bones, vessels, nerves, and tendons.…”

Reverse digital artery island flap with versus without sensory nerve coaptation for finger pulp reconstruction

“…Finger pulp defect is one of the most common hand injuries. The goal of treatment is to restore function, with immediate sensate skin and near‐normal movement 1 . Treatment options are varied, ranging from skin grafting to vascularized flap coverage.…”

“…The goal of treatment is to restore function, with immediate sensate skin and near-normal movement. 1 Treatment options are varied, ranging from skin grafting to vascularized flap coverage. The choice of treatment depends on the shape and size of the defects, skin characteristics, donor site morbidity and the functional demand of the patients.…”