Homodigital Neurovascular Island Flap Research Articles

Reconstruction Results of Fingertip Amputations with Antegrade Homodigital Neurovascular Island Flap

Objectives: The most common amputations to the hand are fingertip injuries. It may be difficult to restore fingertip both functionally and cosmetically in these injuries. In our study, we aimed to evaluate the functional outcomes of patients who underwent antegrade homodigital neurovascular island flap (AHNIF). Methods: Between January 2020 and September 2022, a retrospective analysis was performed on 12 patients who underwent AHNIF due to fingertip injuries. The demographics of the patients, mechanisms of injury, defect sizes, and follow-up durations were documented. Amputation levels were defined. Flap sensitivity was assessed using the static 2-point discrimination test. Range of motion and contractures of the proximal interphalangeal and distal interphalangeal joints were measured. Cold intolerance was evaluated with the Cold Intolerance Symptom Severity (CISS) score. Patient's aesthetic satisfaction was evaluated with the Aesthetic Numeric Analog score. Results: The mean age of the patients was 40.91 years, with a mean follow-up duration of 14.41 months. The mean range of motion for the distal interphalangeal (DIP) joint was 81.6°, and for the proximal interphalangeal (PIP) joint was 92.5°. Flexion contracture was present in five patients, with a mean contracture degree of 6. The mean CISS score for the patients was 4.41, and the Aesthetic Numeric Analog score was 6.33. The mean 2-point discrimination was 5.41 mm. Conclusion: AHNIF is one of the effective methods to restore fingertip function after amputations that cause significant tissue loss. It provides predictable and satisfactory outcomes in terms of flap survival, pulp sensitivity, and mobile adjacent joints.

Outcomes of antegrade homodigital neurovascular island flap in fingertip amputations

BackgroundAntegrade homodigital neurovascular island flap (AHIF) is one of the methods used in fingertip amputations to cover the defect area, preserve finger length and obtain a painless and sensitive fingertip. The aim of this study was to evaluate the functional and sensory outcomes in patients who underwent AHIF for fingertip amputation and to analyze the relationship between patient satisfaction and outcome measures. MethodsTwenty patients with a mean age of 37 (18–63) years were analyzed retrospectively. The patients were evaluated in terms of hook nail development, active interphalangeal joint movements, cold intolerance, and sensory function of the flap covered area. Static two-point discrimination test and Semmes Weinstein monofilament test were performed for sensory evaluation. ResultsAll flaps survived completely at the end of follow-up (mean, 36 months; range 11–64 months). Five patients had cold intolerance and two had hook nails. In total, proximal interphalangeal or distal interphalangeal joint flexion contracture developed in 25 % of the patients. The mean static two-point discrimination score was 4.6 ± 1.6 (2–8) and Semmes–Weinstein monofilament test score was 3.48 ± 0.6 (2.44–4.17). Subjective satisfaction levels of the patients were found to be high and did not show a statistical relationship with the measured clinical outcome parameters (p > 0.05). ConclusionsSince AHIF contains a solid and continuous neurovascular pedicle, the probability of necrosis and loss of sensation is low in AHIF. In addition, the graft need of the donor area is not high. Its disadvantage is the rate of restriction of joint movements. Level of evidenceIV.

The Top-Hat Flap: A New Technique for Segmental Nailbed Reconstruction.

The finger or thumb tip was used as a homodigital neurovascular island flap ("top-hat flap") to reconstruct 28 segmental defects of the distal phalanx, nailbed, or pulp over a 7-year period with a minimum follow-up of 12 months. All flaps survived and all fractures united. A total of 75% of patients achieved full range of motion at the distal interphalangeal joint, 71% achieved 2-point discrimination of less than 6 mm, and 92% returned unrestricted to their preinjury job less than 3 months after injury. The average digit impairment score, based on the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fifth Edition , was 19%. The top-hat flap is an option for the treatment of complex injuries of the finger or thumb tip where there is a segmental defect in the nailbed, distal phalanx, or pulp and a neurovascularly intact finger or thumb tip. Therapeutic, IV.

Long-term patient-reported outcome measures of fingertip coverage with a homodigital unipedicle neurovascular island flap.

We report the long-term patient-reported outcomes and objective outcomes of a homodigital neurovascular island flap for distal phalangeal amputations in the fingers (with the thumb excluded) for 20 patients at a median follow-up of 4.4 years (IQR 2.2 to 12.3). We assessed the global subjective and aesthetic outcomes, range of motion, sensitivity and strength. The patient-reported median subjective global score was 7.5/10 points (IQR 7 to 9) and the aesthetic score was 8/10 points (IQR 8 to 9). Range of motion, sensitivity and strength were similar to the uninjured side. Stiffness was present in more than half of the cases; 14 patients had a hook nail deformity and seven patients reported symptomatic cold intolerance. At a long-term follow-up, the patient-reported outcome measures and objective outcomes of this flap are satisfactory and it is a safe and reliable flap.Level of evidence: IV.

Comparison of Hybrid Abdominal Flap versus Homodigital Neurovascular Island Flap for Fingertip Amputation.

Amputation at the level of the distal phalanx is a common hand injury and is normally treated with replantation. However, if the level of injury is distal or the vessels of the stump have been crushed by injury, replantation cannot be a viable option. The aim of this study is to evaluate the functional and aesthetic outcomes of the “hybrid abdominal flap”, which consists of a random-pattern abdominal skin flap and an autologous bone graft. A retrospective analysis was performed on fingertip amputation patients from March 2019 to April 2021. The patients were managed by either hybrid abdominal flaps (HAFs) or homodigital neurovascular island flaps (HNIFs). The functional and aesthetic outcomes were assessed three months after the operations. In this study, a total of 20 fingers were treated with either HAFs or HNIFs. There was a significant difference in the range of motion (ROM) and the scar quality between the two groups. All of the flaps survived without flap necrosis, and non-union of the bone was not observed. The patients were satisfied with the appearance and function of their fingers, including the ROM and sensory aspects. Our novel HAF is a functionally and aesthetically valid option for fingertip amputations with crushed stumps.

Long-term outcomes of homodigital neurovascular island flap reconstruction of fingertip injuries in children.

We evaluated the long-term functional and cosmetic results of homodigital neurovascular island flap (NIF) used to reconstruct extensive pulp defects with bone exposure in children. Twenty-three children (mean age 4.8 years, range 1–10 years) with fingertip injuries were reconstructed with a pedicled homodigital NIF and evaluated in terms of sensation quality, cold intolerance, scar formation, nail deformity, range of motion and overall finger length at a mean follow up of 7.8 years (range 2–13). Eleven patients reported cold sensitivity in the operated fingertip, and 15 presented with hook nail deformities at the final follow-up. The total active motion of the injured finger was significantly lower than that of the uninjured side (p < 0.001). NIFs is a safe, reliable reconstructive treatment for fingertip loss in children, but commonly encountered issues in the long term include an extension lag of the interphalangeal joints, hook nail deformities and cold intolerance. Level of evidence: IV

Comparison of Clinical Outcomes of Heterodigital Neurovascular Island Flap, Reverse Homodigital Neurovascular Island Flap, and Cross-Finger Flap Used for Fingertip Reconstruction.

The fundamentals of fingertip defect reconstructions should be mainly to restore the sensation with contour and identical pulp volume, and texture. To achieve these, various flap techniques were described in which those had their own advantages and disadvantages to restore the fingertip injuries. This study aimed to compare clinical outcomes of three different local flap procedures widely used for the reconstruction of fingertip defects: heterodigital neurovascular island (HeNI) flap, reverse homodigital neurovascular island (rHoNI) flap, and cross-finger (CF) flap. Between 2014 and 2019, statistical analysis of 58 patients undergoing reconstruction of fingertip defects of 2-5 digits by HeNI flap (n = 16), rHoNI flap (n = 17), or CF flap (n = 25), was performed retrospectively. All cases were reviewed regarding age, gender, etiology of trauma, duration of follow-up, the extent of the injury with the classification system PNB, Quick Disability of Arm, Shoulder, and Hand score (Q-DASH), cold intolerance symptom severity score (CISS), static 2-point discrimination test, ROM value of phalangeal joints and time to return to work. The mean age of all patients was 36.9years with a male-to-female ratio of 5.4:1 and a mean follow-up of 26.72months. The most common cause was work-related (n = 41). The mean of DASH score, CISS score, static 2-point discrimination, time to return to work, and ROM value of DIP joint did not significantly differ between the study groups. The mean ROM values of PIP and MCP joints of patients for CF flaps applied were significantly lower than HeNI flaps. The use of HeNI flap for fingertip reconstruction is a reliable one-stage option in terms of improved ROM of finger joints.

Comparing Flap Advancement and Wound Coverage of Anterograde Homodigital Neurovascular Island Flap Designs: A Cadaveric Model

Anterograde homodigital neurovascular island flaps are a reconstructive option for volar fingertip injuries and confer the advantage of preserving fingertip sensation after surgery. However, the amount of flap advancement and wound coverage provided by stepwise and triangular flap designs remains unknown. This study sought to investigate how incremental proximal dissection of the pedicle influences flap advancement and whether advancement and/or coverage differ between the triangular and stepwise flap designs using 22 paired cadaveric digits. Flap advancement and wound coverage were evaluated in a pairwise design such that each pair of digits received 1 stepwise flap and 1 triangular flap. After creating a standardized injury to the volar fingertip, pedicled flaps were dissected from the middle phalanx and advanced distally under consistent tension. Advancement was measured for each 5 mm of proximal mobilization of the pedicle to a maximum of 30 mm. On average, 2.6 ± 0.2 mm of flap advancement could be achieved for every 10 mm of pedicle mobilization. With 30 mm of proximal mobilization of the pedicle, 11.8 ± 2.8 mm of advancement and 57.2% ± 16.1% of wound coverage could be expected. There were no significant differences between the flap designs. The stepwise and triangular anterograde homodigital neurovascular island flaps offer comparable and consistent reconstructive outcomes for volar fingertip injuries. The findings in this study suggest that the choice of flap design need not be influenced by the considerations of advancement or coverage; rather, surgeon preference or technical differences between the 2 flap designs may be of more importance.

Comparative Study of the Clinical Effects of Reverse Digital Artery Island Flaps and Antegrade Homodigital Neurovascular Island Flaps for Fingertip Reconstruction.

This retrospective study aimed to compare the clinical effects of reverse digital artery island flaps and antegrade homodigital neurovascular island flaps in fingertip reconstruction. We retrospectively analyzed the data of 30 consecutive patients with fingertip defects who had undergone 2 types of surgery from January 2016 to January 2019. We used reverse digital artery island flaps and antegrade homodigital neurovascular island flaps in 14 and 16 patients, respectively. Flap sensitivity was evaluated using the Semmes-Weinstein monofilament test and static 2-point discrimination test. Finger appearance was assessed using the Michigan Hand Outcomes Questionnaire. The operation time, flap sensitivity, range of motion of the interphalangeal joint, and complications were evaluated. The static 2-point discrimination results of the fingers were significantly different between the antegrade homodigital neurovascular island flap group and reverse digital artery island flap group (8.07 ± 1.54 vs 5.94 ± 1.73; P < 0.05). The appearance of the fingers was significantly better in the antegrade homodigital neurovascular island flap group. Surgery using antegrade homodigital neurovascular island flaps required less time than surgery using reverse digital artery island flaps. No significant differences were found between the 2 groups in the range of motion of the interphalangeal joint or complications. The functional outcomes were identical between the reverse digital artery island flap and antegrade homodigital neurovascular island flap methods for fingertip reconstruction. Antegrade homodigital neurovascular island flaps lead to a shorter operation time, a more satisfying appearance, and better sensory recovery.

Long-term outcome of a “short” anterograde homodigital neurovascular island flap with a simple or double V-Y plasty

IntroductionAnterograde homodigital neurovascular island flaps are very useful for reconstructing proximal fingertip amputations with exposed bone but have the disadvantage of bringing about proximal interphalangeal joint (PIPJ) stiffness. The addition of a single or double V-Y plasty increases mobility without having to extend the dissection beyond the PIPJ. The purpose of this study was to examine the long-term functional outcome of patients who received a “short” anterograde homodigital neurovascular island flap with a single or double V-Y plasty. Our primary hypothesis was that this flap did not induce PIPJ stiffness and our secondary hypothesis was that it preserved good fingertip sensation. Materials and methodsThis was a retrospective study of patients operated between August 2017 and February 2019. The inclusion criteria were the following: a fingertip amputation caused by either a crush or laceration injury with exposed bone, treated during the acute phase of the injury or for secondary necrosis (attempted replantation or subtotal amputation) and classified as type II oblique palmar, type III or type IV amputations according to the Allen classification system. The assessment criteria were: joint mobility, sensory evaluation with the two-point discrimination and Semmes–Weinstein monofilament tests, time to healing, postoperative complications, postoperative splinting, duration of work stoppage, perioperative smoking, cold intolerance, touch hypersensitivity, nail deformity and excluded finger. ResultsNine patients (mean age 53.9 years [32–67]) were operated, of which eight long fingers and one thumb. One procedure was complicated by skin flap necrosis. At the mean follow-up of 22.4 months [16–31], the mean mobility for the metacarpophalangeal joint (MCPJ), proximal interphalangeal joint and distal interphalangeal joint (DIPJ) were 92-0-0°, 97.8-1.5-0° and 60.3-6.8-0°, respectively. In comparison to the contralateral side, a significant difference was only detected in the DIPJs. The mean two-point discrimination in the proximal portion of the flaps were 7.1mm on the ulnar side (p<0.05) and 7.6mm on the radial side (p<0.01), while in the distal portion they were 7.3mm (p<0.01) and 7.8mm (p<0.01). The Semmes–Weinstein monofilament test also detected significantly reduced sensation. ConclusionThe combination of a “short” anterograde homodigital neurovascular island flap with a single or double V-Y plasty seems to avoid PIPJ stiffening while preserving good fingertip sensation. Level of evidenceIV; retrospective study.

Homodigital neurovascular island flap according to Venkataswami

Reliable wound coverage of the fingertip and palmar aspect of the middle finger with asensate flap in order to restore early function. Palmar, oblique pulp defects or amputations at the distal finger phalange with uncovered bone, tendons, and/or neurovascular structures. Peripheral perfusion deficiency, size of defect exceeding flap capacity, obliteration of the flap artery, i.e. contralateral finger artery. Harvesting of adipocutane, midlateral triangle based on proper digital vessel flap; distal flap transposition and primary closure of the harvesting defect, flap dimension 4-5 mm larger than defect. Finger splint for 2weeks, followed by exercises with flap conditioning. Very reliable defect coverage with 9% minor and temporary complications, all of which healed without consequences.

Comparing Advancement and Coverage of Anterograde Homodigital Neurovascular Island Flap Designs for Volar Fingertip Injuries Using a Cadaveric Model

BackgroundFollowing injury, normal interaction between the hand and its surrounding environment is dependent on the ability of the surgical intervention to maintain fingertip sensation. To do this, plastic surgeons can use the anterograde homodigital neurovascular island flaps (a‐HNIF) ‐ a technique that uses a pedicled skin flap (i.e., a flap that maintains its neurovascular supply) ‐ to reconstruct a fingertip with sensation. The triangular and step‐wise flap shapes have been described as suitable flap shapes; however, it remains unclear how much advancement and coverage can be expected from either as patient‐specific factors such as tissue elasticity, wound and hand size have limited comparison of the techniques in the clinic.Aim &amp; ObjectivesTo control for these patient‐specific factors, this study uses paired, fresh (not embalmed) cadaveric hands as a model to investigate the amount of flap advancement and wound coverage provided by the triangular and step‐wise a‐HNIF. Comparison of the triangular and step‐wise flap designs was first examined by incrementally increasing proximal dissection to determine the amount of advancement afforded by each of the a‐HNIF techniques (Objective 1). Subsequently, we investigated which flap design ‐ when sutured in place ‐ provides the greatest wound coverage (Objective 2).MethodologyUsing paired digits (2–5), flap designs (triangular or step‐wise) were assigned in an alternating pattern to control for possible confounding patient‐specific factors (Fig. 1). All procedures were performed by a single investigator and 3D printed guides were used to standardize the flap designs as well as the injury elicited to each finger (p&gt;0.05). For every 5mm of proximal dissection of the pedicle, the distance of advancement was measured while using a consistent force of tension (μtension = 0.31 ± 0.02N; p&gt;0.05). Following 30mm of proximal dissection (i.e., approximately the origin of the digital arteries in the palm), the flap was sutured in place to cover the elicited injury and the percent wound coverage was calculated.ResultsOur preliminary results (n=14 digits) indicate that the triangular flap achieved significantly more advancement than the step‐wise flap at ≥25mm of proximal dissection into the hand (p&lt;0.05). At 30mm of proximal dissection, the step‐wise flap provided 75.9 ± 6.9% wound coverage whereas the triangular flap covered 80.1 ± 6.1% of the wound (p&gt;0.05). These findings suggest that both the triangular and step‐wise flap designs offer comparable reconstructive outcomes; however, triangular flaps may be able to achieve these results with less proximal dissection.ImplicationsOur study provides the first specimen‐matched comparison of advancement and coverage provided by the triangular and step‐wise a‐HNIF. The results of this study will help inform flap selection to improve outcomes for patients undergoing volar fingertip reconstruction.Support or Funding InformationNoneFigure 1

Maximal advancement of homodigital neurovascular island flaps

We investigated the maximal advancement of the homodigital neurovascular island flap with the digit in full extension and its correlation to the digital length. In 32 adult cadaveric digits, flaps measuring 1 × 1 cm were sequentially elevated to different dissection points. Dissection of the flap to the proximal interphalangeal joint crease, palmo-digital crease, division of adjacent digital artery and the superficial arch resulted in flap advancement of 8, 12, 15 and 18 mm, respectively. The degree of advancement correlated to the length of the finger and was approximately 19% of the finger length. We conclude that dissection of a homodigital antegrade neurovascular island flap to the proximal interphalangeal joint, palmo-digital crease, after ligation of adjacent digital artery and the superficial arch allows progressively more advancement. The advancement obtained by flap dissection to the palmo-digital crease was about 19% of the finger length.

Long-term outcome of fingertip reconstruction with the homodigital neurovascular island flap.

Fingertip injuries are frequent and several surgical strategies exist to reconstruct the amputated part and restore function and appearance. Yet, long-term results are rarely published. The purpose of this study was to examine the long-term clinical outcome of neurovascular island flaps for traumatic fingertip amputation of Allen type III/IV injuries. We retrospectively analysed a cohort of patients with traumatic fingertip amputation that underwent reconstruction with a neurovascular island flap from January 2003 to December 2014. No mandatory splinting was applied after surgery. 28 participants (29 fingers) were available for follow-up at mean 8years after reconstruction. Activities of daily living were measured with the disabilities of the arm, shoulder and hand questionnaire. Grip strength and finger motion were assessed using a Jamar dynamometer and a goniometer. Two-point discrimination and Semmes-Weinstein monofilaments were used to evaluate sensory recovery. No intraoperative complications occurred and all flaps survived. Mean flap size was 4.7 ± 0.6cm2. Active motion of the fingers was over 95% of the contralateral side at follow-up. Three patients showed mild extension lag of the proximal interphalangeal joint. The grip strength of the affected hand and of each of the affected fingers was over 70% of the contralateral side. In comparison to the contralateral side we did not detect any significant difference for the Semmes-Weinstein monofilament test, but two-point discrimination (5.1 ± 1.7mm) was significantly impaired. According to the Lim classification 1 of 14 nails with hook nail deformity showed grade 3 breaking of the nail. The DASH score was 16.0. All patients returned to their original occupation and patient satisfaction with the procedure was high. The risk for disabling flexion contracture seems to be small even without mandatory splinting. Neurovascular island flaps for fingertip amputation of Allen type III/IV injuries are a reliable tool in fingertip reconstruction in the long term.

Flap Related Complications Requiring Secondary Surgery in a Series of 851 Local Flaps Used for Fingertip Reconstruction.

Local flaps are widely used to cover fingertip defects. Errors in design or technical execution of the flap may lead to morbidity and additional surgical procedure. The purpose of this study was to review flap related complications requiring unplanned secondary surgery to characterize preventable issues. 851 local flaps were used to reconstruct fingertip defects during a 9-year period. Patients requiring unplanned secondary surgery to address flap related complications were subjected to analysis. 31 of 851 flaps (3.6%) required unplanned secondary surgery because of flap related complications. The most reliable flap was VY advancement flap with only one (0.3%) re-operation. The reverse vascular island flap, cross finger flap, and neurovascular island flap were associated with the comparable number of complications (8.0%; 6.3%; and 3.8% respectively). Total or partial necrosis was the cause for re-operation in 6 patients (0.7%). The typical reason for secondary surgery was inadequate soft tissue cover of the tip with homodigital neurovascular island flap and flexion contracture with reverse vascular island flap. Cross finger flaps were revised because of poor graft take at the donor site, bulky flap or flap necrosis. Local flaps are reliable operations to cover fingertip defects. Each flap has potential pitfalls, which may be avoided if the surgeon is aware of them.

Ulnar Thumb Pulp Reconstruction Using the Anterograde Homodigital Neurovascular Island Flap.

The thumb ulnar pulp is a critical component of key pinch and precision manipulation. Injuries to this area should be reconstructed with robust, sensate tissue that restores bulk and contour. The existing reconstructive options, however, have substantial risks and drawbacks. We describe an anterograde homodigital neurovascular island flap that provides both sensate and durable coverage of the ulnar thumb pulp. The flap uses innervated glabrous tissue, limits donor site morbidity to the thumb and first web space, and does not require microvascular anastomoses or nerve coaptation. The flap has been previously described for nonthumb fingertip injuries, but it has not been applied to the thumb. We discuss several important technical modifications that are essential to raising and insetting this flap in the thumb, review potential pitfalls, and highlight key steps to ensuring judicious intraoperative decision making and success.

Functional Outcomes of Antegrade Homodigital Neurovascular Island Flaps for Fingertip Amputation.

Fingertip amputations can be debilitating and challenging to treat, due to the need for both function and cosmesis. We studied the functional outcomes of patients receiving an antegrade homodigital neurovascular island flap for fingertip amputations. From 2004 to 2013, we performed 13 cases of antegrade homodigital neurovascular island flaps. Functional outcomes were studied. Four had Allen Zone II and nine had Zone III injuries. Seven were performed as secondary surgery. The mean followup period was 36 weeks. All the flaps survived. Ten of 11 had less than or equal to 6 mm two-point discrimination. Five patients were noted to have mild flexion contracture at distal interphalangeal joints ranging from 5 to 10 degrees. There were three cases with nail deformity, three with fingertip hypersensitivity and four with cold intolerance. For patients injured on duty, the mean duration of sick leave taken was 18.5 weeks. With careful patient selection, the antegrade homodigital neurovascular island flap is a reliable means of restoring the function of the fingertip after amputation injury with significant tissue loss. Flap survival, sensibility and mobile adjacent joint can be expected, even when performed as a secondary surgery and for patients with work-related injuries.

Finger tip Amputation Injuries. Restoration of Length &amp; Sensibility Using Homodigital Neurovascular Island Flap

Injury of the fingertip is the most common injury of the hand and fingertip amputation is the most common amputation in the upper extremity. The pulp of the fingertip is that part of the finger with the richest vasculature and the highest density of nerve ends. A normal digital pulp is vital to the interaction between the brain and the upper extremity required in the finest daily activities. The contribution of the digital pulp to key pinch and tip pinch depends mainly on its neurovascular integrity. Pulp support by the nail is also needed for tip pinch and key pinch. This report analyses 81 consecutive cases (77 patients - 81 digits) of homodigital neurovascular island flaps operated on by one surgeon between 2002 and 2014. The surgical technique, indications, contra-indications and three year results are evaluated. Overall, these flaps provide reliable vascularity as well as normal sensibility at the distal end of the finger where high quality perception is required.

Troca pulpar: uma solução simples para um problema complexo

INTRODUCAO: A ponta do dedo tem papel importante na qualidade do movimento de pinca bidigital, e seu trauma e comum e dificil de resolver. Na troca pulpar, um retalho neurovascular homodigital em ilha reconstroi a polpa dominante, proporcionando boa cobertura de pele e sensibilidade, usando a polpa nao-dominante. METODO: De janeiro de 2000 a dezembro de 2008, 16 pacientes perderam a polpa digital dominante. A tecnica cirurgica consistiu de um retalho neurovascular homodigital em ilha, vascularizado pela arteria digital palmar da polpa nao-dominante transposto para o lado dominante. A viabilidade do retalho, sua sensibilidade e o deficit das articulacoes interfalangeanas proximal e distal foram analisados. RESULTADOS: Houve media de 8 mm no teste de discriminacao entre dois pontos estaticos para todos os digitos, exceto no dedo anelar. No teste monofilamentar de Semmes-Weinstein, obteve-se escore de 3,61 para D1 e D3, e de 4,31 para os outros dedos. Comparado ao mesmo digito contralateral, obteve-se escore de 2,83 para todos os digitos, exceto para D5, que apresentou maior escore (3,61). CONCLUSOES: A tecnica de troca pulpar apresentou resultados funcionais satisfatorios quanto a viabilidade, sensibilidade e mobilidade digital, priorizando o movimento da pinca. Esse retalho neurovascular local tambem proporciona resultados esteticos aceitaveis, em um unico procedimento cirurgico.

Les lambeaux d’avancement en ilot pulpaire homodactyle des doigts longs. À propos de 32 cas

Aim Evaluation of reconstruction results using a homodigital neurovascular island flap so as to recover long fingers loss fingertip. Patients and methods This was a retrospective study of 32 fingertip-flaps of long fingers practiced on 31 patients. They were young people (mean age: 28 years), often male (77.5%), and manual workers in 55%. The loss fingertip was traumatic in 87%. The fingertip reconstruction has been urgently assured, except in three initially-treated whitlow cases. Results Four criteria value were used to value the results of coverage: Aesthetic, sensitive, functional, and socio-professional. We obtained good results in 72%. Conclusion The homodigital neurovascular island flap is a simple and reproducible technique. It's an excellent method for fingertip reconstruction in Allen type II and III. Despite of some complications, in touch with the initial trauma, this surgery gives back a useful sensitivity and a good aesthetic aspect of the fingertip.