Foucher First Dorsal Metacarpal Artery Flap Versus Littler Heterodigital Neurovascular Flap in Resurfacing Thumb Pulp Loss Defects

Abstract

Our study aims to illustrate the advantages and disadvantages of Foucher's first dorsal metacarpal artery flap and Littler's heterodigital neurovascular flap in thumb pulp reconstruction, by assessing wound healing of donor and recipient sites, sensibility, and functional outcome of the reconstructed thumb. Fourteen male patients were reconstructed either with Foucher (n = 8) or Littler flap (n = 6). Dissection of Foucher's flap was faster than that of Littler's flap. All Littler flaps survived completely, but we experienced 1 partial Foucher flap necrosis. Thumb motility and stability was optimal in all patients. Wound healing of donor sites was achieved in both groups. Two patients reconstructed with Littler flap developed scar contractures and presented a reduced range of motion of donor finger and first webspace, respectively. Although Littler flap resulted in better sensibility and tactile gnosis of the reconstructed thumb-pulp, Foucher flap ensured negligible donor site morbidity, complete cortical reorientation, and better overall hand function.

Volar Resurfacing of the Thumb with a Superficial Circumflex Iliac Artery Perforator Flap after Hydrofluoric Acid Burn

“…The aforementioned neurovascular flaps are not without morbidity, much of which is at the expense of other areas of the hand. Additionally, they do not consistently yield cortical reorientation, 7 and often cannot cover a defect of this size. 8 Furthermore, with neurovascular bundles intact, it is unnecessary to use a neurotized flap for reconstruction.…”

Restoration of Thumb Sensibility with Innervated Reverse Homodigital Dorsoradial Flap

“…Reviewing the literature, we find a mean s2-PD of Foucher flap ranging from approximately 10 to 15 mm, [21][22][23][24] whereas that of Littler flap ranged from 7 to 10 mm. [25][26][27][28] Despite the superior sensibility recovery, the Littler flap has been reported to have a considerably higher rate of donor-site morbidity, such as sensory loss, cold intolerance, reduced ROM, and hypertrophic scars, 25,26,29 probably due to the more invasive manipulation of the palmar neurovascular bundle of the donor finger. In this regard, the major advantage of thumb reverse dorsoradial flap is the mean s2-PD recovery of less than 10 mm with minimal donor site damage and complications.…”

Littler heterodigital neurovascular island flap applied to tissue defects of the distal thumb

“…Iraklis and colleagues compared these two methods and came to the conclusion that they were similar in terms of the potential for development of necrosis, contracture, and reflex sympathetic dystrophy. However, they found that the Foucher flap was significantly superior in regard to cortical reorientation and stereognosis (perceiving the form or identifying an object by touching) [7].…”