Clinical application of dorsal perforator flap of the thumb carrying sensory nerves

Abstract

Objective To investigate the therapeutic effect of including sensory nerves in the dorsal perforator flap of the thumb to cover skin defects. Methods From September 2010 to June 2014, 20 digits in 20 patients with skin defect of the thumb were treated. The defect area was 1.0 cm×1.8 cm to 2.0 cm×2.2 cm in size. Five cases with a defect less than 1.5 cm in the longitudinal dimension were treated with dorsal sensory nerve perforator V-Y advancement flap. Reverse perforator island flap including the thumb dorsal sensory nerve was transferred to cover distal volar or dorsal skin and soft tissue defect of the thumb in 11 cases. Donor sites were directly closed. For 4 cases of distal volar thumb skin defects the donor site of the dorsal sensory nerve reverse perforator island flap could not be directly sutured. A V-Y perforator flap from the dorsum of the thumb was advanced to cover the donor site wounds. The nerve included in the flap was sutured to the dorsal cutaneous nerve or one of the digital nerves to restore flap sensation. Results All 20 flaps survived completely. The patients were follow-up for 6 to 12 months. The color, texture and contour of the flaps were good. Two-points discrimination was 7 to 10 mm on the flap. The function was assessed as excellent in 16 fingers, good in 3 fingers and fair in 1 finger. No complication occurred in the donor site. Conclusion This flap spares the main digital artery and nerve. It is an improvement to the conventional fascia flap and presents as a new method for the treatment of thumb skin defect. Key words: Thumb; Surgical flaps; Perforator