First dorsal metacarpal artery flap with dorsal digital nerve with or without dorsal branch of the proper digital nerve produces comparable short-term sensory outcomes

Abstract

Background The first dorsal metacarpal artery flap, including dorsal digital nerves with or without dorsal branches of the proper digital nerves, can be used to reconstruct thumb pulp defects with good results. However, it is still unclear whether there are differences in the sensory outcomes between preserving or not preserving the dorsal branches of the proper digital nerves. Methods This retrospective cohort study included 137 thumb pulp defect patients who underwent first dorsal metacarpal artery flap reconstruction procedure from October 2015 to June 2019. Patients were divided into two groups according to whether the dorsal branches of the proper digital nerves were preserved. In the non-preservation group (n = 80), the dorsal digital nerves were included in the flap for sensory reconstruction. In the preservation group (n = 57), the dorsal digital nerves and the dorsal branches of the proper digital nerves of the index finger were included in the flap. The stump of the proper digital nerves in the defect was coaptated to the donor nerves of the flap using the end-to-end fashion. At the last follow-up, static two-point discrimination, Semmes–Weinstein monofilament scores, pain, cold intolerance of the reconstructed finger, and patient satisfaction in both groups were compared. Results All patients were followed up for at least 17 months. No significant differences were found regarding pain of thumb pulp, static two-point discrimination, Semmes–Weinstein monofilament score, cold intolerance in the injured finger, and patient satisfaction. The non-preservation group presented slightly shorter operative times (p < 0.05). Conclusion There are no differences at 2 years in postoperative clinical outcomes when dorsal digital nerves are used to reconstruct flap sensation regardless of preservation of the dorsal branches of the proper digital nerves in the first dorsal metacarpal artery flap. Level of evidence: Level III, retrospective comparative study.

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

“…Both the dorsal digital nerve and the dorsal branches of the proper digital nerve were commonly used in island flap to cover the finger defects. Han et al 7 reported that if the dorsal digital nerves were carried in the flap, preserving the dorsal branches of the proper digital nerve had no obvious clinical advantages in the restoration of sensation. Although they can repair finger pulp defects for 1-stage procedure and achieve good sensory recovery, there are several shortcomings, such as noticeable donor-site scarring, hair carrying, and sensory loss on the dorsal side of the finger 3 .…”

“…It is important to preserve the nerve supply of the flap to have good sensation postoperatively. 7,23,30,[32][33][34][35] There is no definite answer regarding which nerve to select when performing the reverse digital artery island flap procedure. Both the dorsal digital nerve and the dorsal branches of the proper digital nerve were commonly used in island flap to cover the finger defects.…”

“…In recent years, the application of the reverse digital proper artery island flap with anastomosis of the dorsal nerve or the dorsal branch of the proper digital nerve has become a more mature surgical procedure. 3,[7][8][9] The procedure has the advantages of easy acquisition, limited to the injured finger, and provides better aesthetic and functional recovery. However, the donor site is located on the dorsum of the finger, leaving the extensor tendon exposed, which may lead to adhesion of tendon, and noticeable scar contracture after surgery, 3 and loss of sensation in the donor area is inevitable.…”

“…It can provide adequate and durable tissue without invading the palm or other fingers. In recent years, the application of the reverse digital proper artery island flap with anastomosis of the dorsal nerve or the dorsal branch of the proper digital nerve has become a more mature surgical procedure 3,7–9 . The procedure has the advantages of easy acquisition, limited to the injured finger, and provides better aesthetic and functional recovery.…”

Effect of dorsal nerve fascial island flap on repairing distal soft tissue defects at the proximal segment of the index, middle, ring, and little fingers

“…Compared with the complex innervation of the index, middle, ring, and little fingers, the origin and distribution of the dorsal digital nerves of the thumb are constant and the diameter of the nerves is larger. A recent retrospective cohort study showed that coaptation of the dorsal digital nerves originated from SBRN with the PPDN in the thumb pulp defect was superior to non-coaptation in sensory recovery [ 17 ]. The discrepancy between the results of the above study and ours may be due to the differences in the dorsal nerves of the thumb and other fingers.…”