Reconstruction of Finger Pulp Defects With an Innervated Distally-Based Neurovascular Flap

Abstract

Finger pulp resurfacing is a challenging reconstructive problem. This article introduces sensory reconstruction of finger pulp defects using an innervated distally-based neurovascular flap raised from the dorsum of the thumb. From May 2015 to May 2017, the innervated distally-based neurovascular flap was used in 36 patients. The mean age at surgery was 37 years (range, 18-61 years). All patients were assessed using the total active motion (TAM) scoring system of the American Society for Surgery of the Hand. The sensitivity of the flap was tested using static 2-point discrimination. Full flap survival was achieved in 35 cases. Partial necrosis at the distal margin of the flap was observed in 1 case. At the final follow-up (mean, 20 months; range, 18-23 months), the mean TAM of the thumb was 206° (range, 188°-238°), including 8 excellent and 28 good results. The mean TAM of fingers was 266° (range, 251°-282°), including 4 excellent and 32 good results. The mean value of static 2-point discrimination was 5 mm (range, 4-7 mm) in the flap, including 31 excellent and 5 good results. The innervated distally-based neurovascular flap raised from the dorsum of the thumb is a reliable alternative for sensory reconstruction of finger pulp defects. Therapeutic IV.