Neurovascular island flap for pulp and nail augmentation in thumb duplication reconstruction

Abstract

Objective To introduce a neurovascular island flap for pulp and nail augmentation, and combined with a dorsally based skin flap approach, to improve the esthetic result in thumb duplication reconstruction. Methods Eight cases of thumb duplication, including 1 Wassel type Ⅱ, 1 type Ⅲ and 6 type Ⅳ, were treated with modified Bilhaut-Cloquet procedure between December 2002 and November 2010. All the patients had significant hypoplasia and asymmetry of the pulp and nail of the duplicated thumbs. Nail and pulp flaps were dissected from the thumb to be excised and transferred to the thumb to be retained. All the patients were follow-up to monitor the esthetic, functional and radiological outcomes. The average follow-up was 80 months (range, 25 to 120 months). An esthetic scoring system was proposed to assess the cosmetic results of thumb duplication reconstruction. Results All the flaps survived. There was no visible surgical scar on the dorsal aspect of the thumb. Pulp and nail fold symmetry was improved in all cases. Nail width and pulp circumference were close to those on the normal side. The proposed esthetic scoring system was able to assess and highlight the cosmetic aspect of the outcome, which was well correlated to the parents’ satisfaction. Conclusion In selected case of thumb duplication with significant hypoplasia and pulp and nail asymmetry, the neurovascular pulp and nail island flap is a safe and effective approach to restore symmetry for esthetic improvement. Key words: Hand deformities, congenital; Surgical flaps; Esthetics