Randomized Prospective Study Comparing Reverse and Direct Flow Island Flaps in Digital Pulp Reconstruction of the Fingers

Abstract

This study compares two therapies for the reconstruction of digital pulp: direct and reverse flow island flaps. Discriminatory sensation and loss of active range of motion were analyzed, with random allocation of nerve suturing. The authors conducted a randomized prospective study of 122 patients with loss of digital pulp substance in one finger between 1995 and 2005. Patients were divided into two groups: direct flow island flap (n = 62) and reverse flow island flap (n = 60). The main outcomes were the capacity to discriminate between two points, and proximal and distal interphalangeal joint motion loss. In the direct flap group, there was no loss of articular mobility in 51 percent of patients in the proximal interphalangeal joint and in 55 percent of patients in the distal interphalangeal joint. The reverse flap group showed no loss of articular mobility of the proximal interphalangeal joint in 85 percent of patients and of distal interphalangeal joint in 82 percent. Maximum amplitude losses of 10 and 15 degrees were observed only in the direct flap group in proximal interphalangeal joint articulation (p < 0.001), and of 10 degrees in 10 percent of patients in distal interphalangeal joint articulation (p < 0.002). All patients (n = 29) with suturing showed a Weber score less than or equal to 8, whereas only four (13 percent) of those without suturing had a score of 8; the rest had higher Weber scores (p < 0.001). The direct island flap resulted in motion loss in both articulations of the finger but with better discriminatory sensation in comparison with the reverse flap.