The Efficacy of Antegrade Homodigital Neurovascular Island Flaps in Distal Fingertip Reconstruction: A Systematic Literature Review

Abstract

Background: Antegrade homodigital neurovascular island flaps (AHIFs) are a heterogeneous group of pedicled flaps used for reconstruction of traumatic digital detipping injuries. While numerous single-center studies have documented their use, there are no large or multicentre studies validating their efficacy, applicability, and functional outcomes. We performed a systematic review of the contemporary literature to establish the safety and functional outcomes of this technique. Methods: Electronic searches were performed using PubMED, Embase, and MEDLINE from inception date to October 2020, with further studies identified from study reference lists and independent searches. Relevant studies reported on complications and functional outcomes of the AHIFs, as used for digital detipping injuries. Data were then extracted and analyzed. Results: Twenty-seven studies published between 1974 and 2019 yielded 744 patients. Four studies provided incomplete epidemiologic data, resulting in a total of 559 patients with 584 digital injuries. Index and middle fingers were most frequently involved. Mean final 2-point discrimination (2-PD) was 4.9 mm static and 5.1 mm dynamic, with dynamic 2-PD reported in 2 studies. Mean total active motion of the digit was 200.3°. Mean time to return to work was 6.7 weeks in 10 studies. Flap survivorship was found to be 99.6% in 23 studies. Cold intolerance was the most common complication at 18%, followed by pain and hypersensitivity. Conclusions: Antegrade homodigital neurovascular island flaps provide a safe and effective method of treating distal finger amputations, yielding satisfactory functional outcomes across all ages. Further studies comparing outcomes between the AHIFs and other reconstructive modalities would be useful.

Long-term patient-reported outcome measures of fingertip coverage with a homodigital unipedicle neurovascular island flap

“…As in the larger series, such as those of Foucher et al (1989) and Smith and Elliot (2000) and the systematic review performed by Castillo et al (2022), we found a low incidence of complications. In particular there were no cases of complete flap necrosis, despite most surgeons in our study not being experienced hand surgeons.…”

“…As in the larger series, such as those of Foucher et al. (1989) and Smith and Elliot (2000) and the systematic review performed by Castillo et al. (2022), we found a low incidence of complications.…”

“…Features, such as stiffness, neuromas and flap necrosis, which we would expect to be related to this type of reconstruction, were less often reported. Castillo et al (2022) carried out a systematic review of 27 articles reporting the results of antegrade homodigital neurovascular island flaps in 584 digital injuries The mean follow-up was 31 months, the mean s-2PD was 5 mm, the mean TAM was 200 , the mean return to work was 6.7 weeks and most patients were satisfied with their results. Partial and total necrosis of the flap was reported in 5% and 3%, respectively, and 18% had cold intolerance.…”

“…Castillo et al. (2022) carried out a systematic review of 27 articles reporting the results of antegrade homodigital neurovascular island flaps in 584 digital injuries The mean follow-up was 31 months, the mean s-2PD was 5 mm, the mean TAM was 200°, the mean return to work was 6.7 weeks and most patients were satisfied with their results.…”