Modified Littler flap for sensory reconstruction of large thumb pulp defects

Wang, Hui; Yang, Xiaoxi; Chen, Chao; Wang, Bin; Wang, Wei; Song, Jia

doi:10.1177/1753193417754191

Cited by 17 publications

(13 citation statements)

References 39 publications

(47 reference statements)

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“…With its advantages and disadvantages, the Littler flap remains one of the most used techniques in thumb pulp defect coverage, with the above mentioned indications [21,22] . The results of the current report were satisfactory in terms of cortical reintegration of the neo-thumb.…”

Section: Discussionsupporting

confidence: 54%

“…The esthetic and functional outcomes did not differ much from those obtained using the classical Littler technique [22] . The phenomenon of “double sensitivity” was solved by nerve reanastomosis.…”

Section: Discussionmentioning

confidence: 73%

“…The esthetic and functional outcomes did not differ much from those obtained using the classical Littler technique. [ 22 ] The phenomenon of “double sensitivity” was solved by nerve reanastomosis. According to mean values of 2PD test, the results were better when using the classical Littler technique.…”

Section: Discussionmentioning

confidence: 99%

“…Attempts have also been made to modify the technique at the same time as reanastomosis, nerve reanastomosis being done to any digital collateral nerve of the traumatized thumb. [ 22 ] Paresthesias were found to be more common when the classical Littler technique was used. The Semmes-Weinstein and 2PD static and dynamic tests showed no significant differences in the case of nerve reanastomosis compared with the classical technique.…”

Section: Discussionmentioning

confidence: 99%

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Utility of “reposition-flap” in the reconstruction of the avulsed thumb

et al. 2021

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Injuries that result in thumb amputation cause a loss of 50% of hand function. Microsurgical replantation remains the gold standard of thumb reconstruction techniques. The non-microsurgical technical variants of thumb reconstruction described so far aim to create a neo-thumb of adequate length, stable, opposable, sensitive, and last but not least esthetically pleasing appearance. Avulsion of the distal phalanx and the absence of the nail will determine a functional deficit but also an unesthetic appearance. When replantation is not possible or the patient refuses to “sacrifice” another anatomical region for thumb reconstruction, the “reposition-flap” technique can be used. Although often controversial, this surgical technique deserves proper attention and should be used in some cases. We studied a group of 32 patients with distal thumb amputations. In patients with amputations in zone II according to Tamai, with interphalangeal joint preservation, the thumb was reconstructed using “reposition-flap” with an O’Brien flap in 15 cases. In the remaining 17 cases where the amputation was at the level of the interphalangeal joint, we used the same technique, but the thumb neopulp was reconstructed with the Littler heterodigital neurovascular flap harvested from the ulnar border of the middle finger in 11 cases or radial border of the ring finger in 6 cases. The results were evaluated from a functional (Kapandji score), sensitive (2-point discrimination, Semmes-Weinstein test) but also esthetically (patient satisfaction) point of view. Donor site morbidity, cold intolerance, the presence of nail dystrophy, and bone resorbtion were also assessed. The disabilities of the arm, shoulder and hand score was evaluated for each patient. Although various surgical and microsurgical techniques for thumb reconstruction are described, when choosing the technique to use we must first consider patient's wishes. A well-informed patient will be able to make, with the surgeon, the best decision for him concerning the reconstruction option.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Utility of “reposition-flap” in the reconstruction of the avulsed thumb

et al. 2021

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“…If the pulp defect is more than 2.5 cm in length, another reconstructive possibility is a neurovascular island flap, raised from the dorsal aspect of the proximal phalanx of the index and supplied by the radial digital artery (Toros et al, 2018) or from the dorsum of the middle finger and nourished by the ulnar digital artery (Tang et al, 2014;Wang et al, 2018;Zhang et al, 2011). The dorsal branch of the digital nerve is harvested with both of these flaps (Figure 6).…”

Section: Other Flaps For Larger Defectsmentioning

confidence: 99%

Soft and tissue repair of the hand and digital reconstruction

Adani

Tang

Elliot

2021

J Hand Surg Eur Vol

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This article summarizes the current views and proposed approaches to treating soft tissue defects of the hand. The article also outlines some key considerations of digital reconstruction. There are many options in treating soft tissue defects. For defects of the hand, local flaps are primarily considered if the defects are small or moderate in size. A vascularized free flap is only considered for a defect of large size (3 cm long or larger). Thumb reconstruction is of primary importance, while reconstruction of two fingers is necessary when all fingers are lost. Reconstructions of a missing distal part of a finger or reconstruction of an entire finger if only one finger is lost are cosmetic restorations; functionally these defects do not need reconstruction. Sensation is of great importance in repair or reconstruction of the tip of the thumb or finger. Therefore, sensory evaluation is a key factor in assessing and selecting the best options of surgery.

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