The pulp switch flap: An option for the treatment of loss of the dominant half of the digital pulp

Abstract

The fingertip has an important role in bi-digital pinch quality, and pulp loss is common and difficult to solve. The pulp switch consists of a pulp island flap with a homodigital neurovascular pedicle, vascularized by the palmar digital artery of the non-dominant pulp transposed to the dominant pulp side. We report the results in 16 patients treated for loss of the dominant half of a digital pulp from January 2000 to December 2008. On review after a minimum of 6 (range 6-18) months, the Weber's test demonstrated an average of 8 mm in static 2 point discrimination test for all digits, except the ring finger. In the monofilament Semmes-Weinstein test, we obtained a score of 3.61 for the thumb and little fingers, and 4.31 for the other fingers. We did not find partial or total necrosis of the flap. The pulp switch flap gave satisfactory functional results for viability, sensitivity, and digital mobility providing a sensate bi-digital pinch with acceptable aesthetic results in a single surgical procedure.

Modified Littler flap for sensory reconstruction of large thumb pulp defects

“…Furthermore, donor-site morbidity should also be minimized. Local transposition flaps, advancement flaps and homodigital neurovascular island flaps are common techniques for the reconstruction of fingertip and pulp injuries with satisfactory sensory recovery (Atasoy et al, 1970;Baumeister et al, 2002;Lanzetta et al, 1995;Ni et al, 2012;Sano et al, 2008;Silva et al, 2013;Thoma and Vartija, 2010). However, these methods are recommended only for small to moderate dimensional defects (<2 cm in length).…”

Modified anterograde pedicle advancement flap in fingertip injury

“…A variety of surgical techniques that aim for preservation of digital length are available for reconstruction of the fingertip. They include the use of local flaps, such as volar V-Y flaps (Atasoy et al, 1970), lateral V-Y flaps (Shepard, 1983), anterograde advancement flaps (Evans and Martin, 1988;Mutaf et al, 2012;Silva et al, 2013), reverse island flaps (Yazar et al, 2010), crossfinger flaps (Cohen and Cronin, 1983;Lee et al, 2012), and thenar flaps (Dellon, 1983;Rinker, 2006) as well as free flaps requiring microsurgical techniques, such as radial artery superficial palmar branch free flaps (Yang et al, 2010), medial plantar perforator flaps (Huang et al, 2010), and partial toe transfer (Lee et al, 2008;Yoon and Lee, 2012).…”