Volar Neurovascular Advancement Flap With an All Neural Branch–preserving Technique

Abstract

Several fingertip reconstruction options exist, among which, the use of a volar advancement flap or local transposition flap is a simple and effective technique for reconstructing the volar pulp with the same skin texture. To advance the flap, we have to release the tethering structure and sometimes include the neural branches. We describe a concept of an all neural branch-preserving technique to harvest a volar flap. We demonstrate this technique on an anatomic specimen and 1 case with delicate surgical tips. We performed this technique in 16 patients, and the mean follow-up period was 28.4 months. The mean range of motion of the distal interphalangeal joint was 70.3 degrees, and that of the proximal interphalangeal joint was 101.9 degrees. The mean static 2-point discrimination of the volar pulp was 4.8 mm. This technique could be applied on the volar advancement flap with a better sensation recovery.

Functional and aesthetic reconstruction of a dorsal digital skin defect with a sensory neurotized DMCA III flap

“…The concept of restoring digital defects with sensate flaps is not new, yet gaining more and more popularity with the evolution of microsurgery and the challenge of the surgeon to improve his results [ 6 , 7 ].…”

Advancing Fingertip Regeneration: Outcomes from a New Conservative Treatment Protocol

“…Fingertip injuries, particularly those involving volar pulp tissue defects, present a significant challenge in hand surgery due to the complex anatomy and the critical role of the fingertip in sensory and motor functions [1]. The volar pulp, with its rich neurovascular network and specialized sensory receptors, is essential for fine touch sensation, grip stability, and precise manipulation [2]. Injuries to this region can lead to significant functional impairment, sensory disturbances, and cosmetic disfigurement, ultimately impacting the patient's quality of life [3].…”