Flap Sensation Research Articles

Free super-thin peroneal artery perforator flap containing neurovascular axis for coverage of hand or foot tissue defects

Objective To investigate the clinical results of free super-thin peroneal artery perforator flap containing neurovascular axis in reconstruction of hand or foot soft tissue defects. Methods A retrospective case series study was made on 23 cases of hand or foot soft tissue defects admitted from January 2006 to March 2013. There were 16 males and 7 females, with a mean age of 33 years (range, 17-51 years). Wounds were located in dorsal hand (n=12), dorsal pedis or amputated forefoot (n=8), greater thenar (n=2) and index finger (n=1) respectively. Defects ranged in size from 5.0 cm×3.5 cm to 11.5 cm×7.5 cm. Flap elevating was performed underneath the deep fascia and the perforator supplying the flap was dissected thoroughly, ligated and cut at the location arose from the peroneal artery. Most of the deep fascia except stripe shaped areas along the main blood supply chains was moved sharply and the fat underlying thinned primarily to the subdermal vascular network. After transferred to the recipient site, the flaps were revascularized by anastomosis of the perforating artery and its venae comitantes to appropriate recipient vessels. A total of 15 cases received innervated flap reconstruction. Flap vascularity and cosmetic results were recorded. Hand function was evaluated with the standard set up by the hand surgery branch of Chinese Medical Association. For foot reconstruction, shoe wearing status, gait, pressure-sore, flap sensibility, donor site appearance and complications were evaluated. Results All flaps were transplanted successfully with satisfactory cosmetic results, except that one flap used to cover dorsal ring finger defect left slightly bulky appearance. Mean duration of follow-up was 19 months (range, 11-26 months). For hand reconstruction, the functional results were excellent in 6 cases and good in 9 cases. Repairing of foot defects with the flaps caused no problem of shoe wearing and no sore occurred. Normal gait was acquired except two cases of partially amputated foot. If innervated, flap sensibility was restored at least to the degree of S3. Protective sensation and touch-pressure sensation were restored in eight non-innervated cases, and two of them were recovered to the degree of S3. There was only suture or small grafting scars on the donor leg and partially sensibility loss of lateral foot without functional defects in 13 cases. Conclusion Free super-thin peroneal artery perforator flap containing neurovascular axis is an easy and reliable technique that can attain satisfactory results for accurate coverage of hand or foot soft tissue defects. Key words: Surgical flaps; Hand injuries; Foot

Cross finger flap cover for fingertip injuries

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Fingertip injuries are the most common form of hand injuries. Restoration of the anatomy is a technical challenge and is one of the basic tenets of the management of fingertip injuries. The cross finger flap is simple and easy to do and is a very useful tool in reconstruction of the pulp of the finger. The project aimed to study the efficacy of cross finger flap in the coverage of fingertip injuries.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">The study was conducted on a prospective basis in Sri Ramachandra University Hospital in Chennai. The study period was from May 2013 to August 2016. All adults who had fingertip injuries who had undergone cross finger flap cover were included in the study. Patients who had other flaps for reconstruction and who were lost for follow-up were excluded from the study. Preoperative parameters which were recorded were mechanism of injury, size of defect, size of the flap, location of donor site and method of coverage of secondary defect. Outcome measures recorded were flap viability, flap sensibility using two-point discrimination, range of motion of fingers, grip strength and presence of other complications</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">40 patients were included in the study. Six were lost for follow-up. Mean follow-up was 14 months. All flaps survived. Full range of motion was obtained in 87% of patients. Average grip strength was 94% for dominant hand injuries and 78% for non-dominant hand injuries. Mean quick DASH score was 10.5. Mean two-point discrimination was 15.4 mm. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Cross finger flap is very effective for coverage of volar fingertip defects with minimal residual problems.</span></p>

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

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

Optimizing Outcomes following Total and Subtotal Tongue Reconstruction: A Systematic Review of the Contemporary Literature.

Background More than 45,000 Americans are diagnosed with oropharyngeal cancer annually and multimodal treatment often requires wide excision, lymphadenectomy, chemotherapy, and radiation. Total and subtotal lingual resection severely impairs speech, swallow, and quality of life (QoL). This study investigates functional outcomes and QoL following subtotal and total tongue resection with free tissue transfer reconstruction. Materials and Methods A systematic review of the English language literature was performed using PubMed, Ovid, Embase, and Cochrane databases based on predetermined inclusion/exclusion criteria. Included studies were reviewed for surgical technique, adjuvant treatment, surgical and functional outcomes, and QoL. Results From an initial search yield of 1,467 articles, 22 studies were included for final analysis. Speech intelligibility was correlated with the volume and degree of protuberance of the neotongue. Adjuvant therapy (radiation) and large tumor size were associated with worse speech and swallow recovery. At 1 year follow-up, despite 14 to 20% rates of silent aspiration, 82 to 97% of patients resumed oral feeding. Neurotized flaps have been demonstrated to improve flap sensation but have not yet demonstrated any significant impact on speech or swallow recovery. Finally, many patients continue to experience pain after surgery, but patient motivation, family support with physician, and speech therapist follow-up are associated with improved QoL scores. Conclusion Tongue reconstruction is dictated by the amount of soft tissue resection. Taking into consideration the most common factors involved after tongue resection and reconstruction, further studies should focus on more objective measurements to offer solutions and maximize final outcomes.

Bilateral big toe wrap-around flap for reconstruction of the defects of the finger

Objective To investigate the therapeutic effect of bilateral combined flap transfer in reconstruction and repairation of thumb and finger defects. Methods A partial fibular side wrap-around flap was harvested from both big toes. The flaps were tailored and designed based on measurements taken from the finger of the intact side. These two flaps were combined to reconstruct the defects of the finger. From March, 2008 to December, 2015, a total of 9 fingers (9 cases) which had defect degrees range from Ⅰ° to Ⅲ° underwent reconstruction surgeries in this way. Appearance, sensation and function of the thumb and foot flap were followed-up. Simultaneously how to improve the outcoming and success rate were explored and investigated. Results All 9 thumbs and fingers in 9 cases with these procedures were survived. No vascular crisis happened. All patients were followed up from 3 to 24 months. The reconstructed thumbs and fingers were all with abundant blood supply, having similar shape to the normal thumbs and fingers, good pain and temperature sensation, with two-point discrimination of 4-8 mm. All patients were satisfied with the thumb and finger shape, regained life and work ability as before. The donor sites had no obvious discomfort, and walking and weight-bearing function remained normal. Judged by the tentative evalution standard of function of upper limb, which was made by Chinese Medical Association for Surgery of the Hand. The results were excellent in 6, good in 2, fair in 1. Conclusion There is less damage on foot and most hand function recovery using bilateral combined flap transplantation to repair multiple fingers defect. Key words: Finger; Toe; Big toe wrap-around flap; Reconstruction; Microsurgical operation

Repair the lateral skin and soft tissue defect of the middle and rear foot wih the plantar medial flap transferred before the achilles tendon

Objective To investigate the methods of repair the lateral skin and soft tissue defect of the middle and rear foot with the plantar medial flap transferred before the achilles tendon. Methods Fifteen cases with the lateral skin and soft tissue defect of the middle and rear foot were repaired with the plantar medial flap pedicled with posterior tibia artery transferred before the achilles tendon from January, 2012 to October, 2015. All the 15 patients were followed up in the way by telephone or back to hospital postoperatively 3 months to 3 years, including 6 cases by telephone follow-up and 9 cases of back-to-hospital follow-up, to observe the appearance, functions of the skin flap and whether the skin flap survived well. Results The flaps of 15 cases survived well. Postoperative follow-up of 3 months to 3 years, the sensation of the flap was good, without any ulcer or necrosis. The patients walked well and were satisfied with the flap. Conclusion To repair the lateral skin and soft tissue defect with the plantar medial flap transferred before the achilles tendon as a new method is feasible with the good ability of faster sensory recovery, the good appearance and function. Key words: Plantar medial flap; Achilles tendon; Middle and rear foot; Skin and soft tissue defect

Clinical application of dorsal metacarpal artery composite flap for coverage of tendon and skin defects of the fingers

Objective To discuss the surgical techniques and treatment outcomes of one-stage repair of complex soft tissue and extensor tendon defect of the fingers by transferring dorsal metacarpal artery flap that includes extensor indicis proprius (extensor digiti minimi proprius) tendon and dorsal cutaneous nerve. Methods From April 2013 to September 2015, 6 cases of middle finger dorsal complex tissue defect were managed with dorsal metacarpal artery composite flap transfer for skin coverage, extensor tendon repair and sensory restoration. The flap size that covered these defects ranged from 6.0 cm×2.0 cm to 7.0 cm×3.0 cm.The donor site was directly closed.Passive functional exercise was initiate done one week postoperatively and lasted for 4 to 6 weeks. Results All 6 flaps survived completely. All the patients were follow-up for 3 to 13 months with an average of 8.2 months. Sensation of the flaps recovered to S3 level. Two-point discrimination was 7 to 10 mm while the mean value was 8.6 mm. The color, texture and contour of the flaps were good. Mobility of the hand was satisfactory. Conclusion Dorsal metacarpal artery composite flap transfer is a reliable way to cover complex tissue defects on the dorsum of fingers. It has consistent vascular anatomy, affords extensor tendon and cutaneous nerve reconstruction along with skin coverage, shortens treatment time, and improves outcomes without added risks. Key words: Surgical flaps; Finger injuries; Metacarpal artery; Compound tissue flap

Anatomic study of medial sural artery lobulated perforator flap and its application in coverage of skin defects of the hand or foot

Objective To provide anatomic details of medial sural artery lobulated perforator flap and report the clinical outcomes of applying this flap to repair soft tissue defects in the hand or foot. Methods Microsurgical dissection was performed in 6 fresh adult cadaver lower limbs to observe medial sural artery and its perforators and measure the pedicle length, external diameter, the number of perforators, the longitudinal distances between the perforating point to popliteal crease and posterior midline of the leg, and its relationship to the sural nerve. A lobulated flap was then designed based on the medial sural artery and its 1st and 2nd myocutaneous perforators to cover soft tissue defects in the hand or foot in 6 cases. The size of the flaps ranged from 4.5 cm×10.0 cm to 6.0 cm×17.0 cm. Results A total of 10 medial sural perforators were found in the 6 leg specimens, with 1 to 2 perforators in each leg (on average 1.7). The perforating points were found in an area of 5.8 to 9.9 cm from popliteal crease and 1.7 to 3.7 cm from posterior midline of the leg. The average longitudinal distance from the first perforator to popliteal crease was (6.77±0.75) cm and (2.17±0.34) cm to posterior midline. The average horizontal distance to sural nerve was (3.23±0.20) cm. The external diameter of vessel pedicle at the initial part of medial sural artery was (2.43±0.31) mm, while external diameter of the perforator at deep fascia was (0.71±0.11) mm. Clinically the lobulated flaps survived uneventfully in 5 cases. Venous crisis occurred in one flap due to subcutaneous hematoma. Surgical exploration of the vascular pedicle and hematoma removal rescued the flap. All flaps achieved desirable appearance and sensation. Follow-up ranged from 4 to 12 months, the average being 7 months. Two-point discrimination was 6 mm on average. As for the donor sites, there was no impairment of motor function. Conclusion The presence of medial sural artery perforator is consistent. Adequate vascular pedicle length and desirable caliber for anastomosis can be acquired when the original artery is included. Sensation of the flap can be partially restored if the sural nerve is included in the flap. With accurate preoperative perforator localization, the lobulated flap configuration is ideal for coverage of multiple soft-tissue defects of the hand and foot. Key words: Dissection; Surgical flaps; Perforator; Medial sural artery

A comparative study of anterolateral thigh perforator flap with and without sensory nerve graft for sensation reconstruction in head and neck region

Objective To compare the operation effects of sensation restoration after tumor resection in the head and neck defects reconstruction by anterolateral thigh flap with or without sensory nerve transplantation. Methods The application of 76 cases anterolateral thigh flaps in head and neck defects reconstruction after tumor resection from May, 2011 to May, 2015 were observed. 35 patients underwent simultaneous reconstruction with sensory nerve anastomosed perforator based anterolateral thigh flap and 41 patients underwent simultaneous reconstruction without sensory nerve graft based anterolateral thigh flap, which was named as group A and group B, respectively. The treatment effectiveness of the two groups was compared and graded into First, Second and Third rate. Results All the 76 flaps survived. Satisfying morphology for the maxillofacial region and stage-one healing for the donor site was available. During the 24-week follow-up, group A were 65.71% (First rate) , 28.57% (Second rate) , 5.72% (Third rate) respectively, and the condition of group B were 31.70%, 26.84%, 41.46%. The treatment effectiveness of group A was better than that of group B. Postoperative complications were less than group B (P < 0.05) . Conclusion Compared with the loss of nerve transplantation of anterolateral thigh perforator flap, sensory nerve anastomosed perforator based anterolateral thigh flap is of great value to reconstruct the defect after resection of tumor in head and neck region and restore the sensation of flap. Key words: Head and neck region; Reconstruction; Anterolateral thigh perforator flap; Sensation reconstruction

Clinical application of lower leg posterolateral perforator flap with preserved sural nerve

Objective To explore the surgical techniques of preserving sural nerve and lesser saphenous vein while harvesting lower leg posterolateral flap based on distal perforator of the fibular artery, and evaluate the treatment results of repairing foot and ankle defects with the flap. Methods From May 2011 to September 2013, soft tissue defects around the foot and ankle in 12 patients were repaired by transferring fibular artery distal perforator flap. The sural nerve and lesser saphenous vein were left intact in the donor site, while the sural neurovascular network was included in the lower leg posterolateral flap. The defects were caused by trauma in 6 cases, by chronic diabetic ulceration in 4 cases, and by necrosis following infection in 2 cases. The size of the wounds ranged from 4.0 cm×2.5 cm to 8.0 cm×5.0 cm. Flaps size ranged from 9.0 cm×4.0 cm to 17.0 cm×7.0 cm. Skin grafts were applied to cover the donor sites. Postoperatively, blood supply of the flaps, swelling of the leg, and pain were closely monitored for 10 days. Flap appearance, contour, and sensation were evaluated later. Questionnaire survey of patient satisfaction of the flap and AOFAS scoring were performed 6 to 12 months postoperatively. Results Complete survival was seen in 10 flaps. Two flaps had partial marginal necrosis in the distal portion, which were managed with surgical debridement. The wound healed in two months. Nine patients had more than 12 months′ follow-up. The flaps had good appearance and good contours. Swelling of the leg was minimum. Pain, temperature and touch perception of flaps at 12 months postoperatively indicated S3 sensory recovery. Patients were satisfied with the appearance of the flaps. The AOFAS scores were 87 to 93, the mean score being 90.2. Conclusion Posterolateral lower leg flap pedicled on fibular artery distal perforator can be safely raised without severing the sural nerve and lesser saphenous vein, which minimizes donor site morbidity without compromising blood supply of the flap. Key words: Surgical flaps; Wounds and injuries; Sural nerve; Perforator

Distally based sural flap for ankle and foot coverage in children

BackgroundCoverage of soft-tissue defects of the ankle and foot is often challenging. The distally based sural fascio-cutaneous flap is useful for reconstructing the lower leg, ankle, heel, and foot but has rarely been evaluated in paediatric patients. The objectives of this study were to assess the reliability of this flap in paediatric patients, to describe the complications associated with its use, and to define its indications in paediatric patients with soft-tissue defects of the ankle and foot. HypothesisWe hypothesised that the sural flap was reliable for covering soft-tissue defects at the ankle and foot in paediatric patients. Material and methodsA distally based sural fascio-cutaneous flap was used to cover soft-tissue defects of the ankle and foot in 20 paediatric patients between 1997 and 2013. The evaluation at last follow-up included a physical examination and determination of the modified functional Kitaoka score. Mean follow-up was 50.6 months (range, 10–192 months) and mean patient age at surgery was 8.8 years (range, 1.5–17 years). Trauma was the most common cause of soft-tissue defect (n=12); other causes were surgical-site infections (n=2), tumours (n=3), chronic ulcer (n=1), burn injury (n=1), and infusion fluid extravasation (n=1). ResultsOf the 20 flaps, 16 (80%) remained fully viable, whereas 4 developed partial necrosis requiring excision and skin grafting, which consistently ensured a good outcome. Other complications consisted of marginal necrosis (n=4), unsightly donor-site scars (n=5), and infection (n=2). Abnormal flap sensation was noted in 11 patients. The mean modified Kitaoka score was 65/80 (range, 0–80), and the score value indicated that function was excellent in 9 (45%) patients, good in 9 (45%) patients, and poor in 2 (10%) patients. DiscussionThe distally based sural fascio-cutaneous flap is a method of choice for covering soft-tissue defects of the ankle and foot in paediatric patients. This reliable flap spares the major blood vessels and has a strong blood supply. Its best indication is coverage of an acute traumatic soft-tissue defect with exposure of a vital structure. In patients requiring late reconstruction, caution is in order when considering the use of a distally based sural fascio-cutaneous flap, which can induce delayed complications, most notably at the donor site. Level of evidenceIV, retrospective case-series study.

Modified first dorsal metacarpal artery island flap for sensory reconstruction of thumb pulp defects.

Restoration of tactile sensation after reconstruction of a thumb pulp defect is import for hand function. We describe our clinical experience using a modified first dorsal metacarpal artery island flap innervated by the radial dorsal branch of the proper digital nerve and the terminal branch of the superficial radial nerve in 20 consecutive cases. The results were compared with 25 patients treated by the conventional Foucher's first dorsal metacarpal artery flap without nerve repair. At the final follow-up, flap sensation was assessed using static two-point discrimination and Semmes-Weinstein monofilament testing. All flaps survived uneventfully in both groups. At the final follow-up, the mean values for static two-point discrimination and Semmes-Weinstein monofilament testing in the study group were significantly different from the values in the control group. The modified first dorsal metacarpal artery island flap provides a reliable and simple option for sensory reconstruction of thumb pulp defects. Therapeutic, level III.

Repair of skin and soft tissue defects around the knee joints combined with patellar ligament defects using free anterolateral thigh flaps with iliotibial tracts

To observe clinical efficacy of using free anterolateral thigh flaps with iliotibial tracts in repairing skin and soft tissue defects around the knee joints with patellar ligament defects. Twelve patients with skin and soft tissue defects around the knee joints and patellar ligament defects were hospitalized from June 2010 to June 2014. The defects of skin and soft tissue ranged from 7 cm × 6 cm to 16 cm × 12 cm in area, and patellar ligament ranged from 5 to 12 cm in length and 2.5 to 4.0 cm in width. Free anterolateral thigh flaps with iliotibial tracts were used to repair these defects. During reconstruction of patellar ligament, both ends of iliotibial tract were successively folded to form tendon-like three-layer structure at first, and then the newly formed structure was wrapped around the broken ends of patellar ligament and fixed with suture. The flap size ranged from 9 cm × 8 cm to 18 cm × 14 cm. The iliotibial tract ranged from 7 to 14 cm in length and 8 to 12 cm in width. The donor sites were closed by grafting with autologous split-thickness skin harvested from thigh or trunk, and parked with gauze. Immediately after operation, the knee joints were fixed in extension with orthosis for 6 weeks. Weight bearing training of affected limbs being kept in extension position was started from 2 weeks after operation, and flexion and extension exercise of affected knee joints was begun from 6 weeks after operation. Before operation and 12 months after operation, the degree of pain around the knee joints and knee joint function were evaluated with the international knee documentation committee knee uation form, and the ranges of flexion and extension of knee joints were also evaluated. The integrity of reconstructed patellar ligament was assessed by color Doppler ultrasound from 6 to 12 months after operation. The occurrence of surgery-related complications was observed in all patients within 12 months after operation. (1) After operation, all flaps survived well, and all wounds healed well. (2) The average score of pain around the knee joint was increased from 31 points before operation to 77 points in 12 months after operation. The average score of knee joint function was increased from 14 points before operation to 65 points in 12 months after operation. Before operation, the average ranges of flexion and extension of knee joint were respectively 89° and 65°, and they were respectively increased to 130° and decreased to 15° in 12 months after operation. From 6 to 12 months after operation, color Doppler ultrasound showed that the condition of reconstructive patellar ligaments in all patients was good without the need for further surgical intervention; the superficial sensation of the flaps was recovered in different degrees. No surgery-related complication was observed in all patients within 12 months after operation. Free grafting of anterolateral thigh flap with iliotibial tract is an effective and reliable method for repairing skin and soft tissue defects around the knee joints combined with patellar ligament defects, and the surgical procedure can recover function and appearance of knee joint satisfactorily.

Thinned chimeric radial collateral artery perforator flap in complex distal thumb reconstruction.

Tissue loss accompanied by bone defects in the thumb is a challenging reconstruction problem. Traditional repair methods are unsatisfactory. Microsurgical thumb reconstruction was performed using 13 thinned chimeric radial collateral artery (RCA) perforator flaps. The flap was created with a thinned skin paddle and humeral bone segments using independent perforators. Primary defatting was completed when the thickness of the perforator entry was approximately similar to that in the periphery. The posterior cutaneous nerve of the arm was carried to make a sensory flap. Defects were 8.5 × 4.5 cm(2) on average (ranging in size from 4.5 × 1.5 to 15.0 × 6.0 cm(2)), and flap size was 9.0 × 5.5 cm(2) on average (ranging in size from 5.0 × 2.0 to 16.0 × 7.0 cm(2)), whereas the humeral fragments were 2.0 × 1.0 cm(2) on average (ranging in size from 1.5 × 0.5 to 4.0 × 1.5 cm(2)). All data were expressed as mean ± SD. The cosmetic appearance of the donor and recipient sites, Kapandji opposition score and static two-point discrimination of the operated thumb were evaluated during a follow-up visit. Follow-up time was 16.6 months (ranging from 14 to 28 months). Flap thickness before defatting, measured immediately after flap elevation was 14.5 mm (ranging from 10.0 to 25.0 mm). Average flap thickness after defatting was 3.5 mm (ranging from 3.0 to 6.0 mm). Venous congestion occurred in two cases. Successful microsurgical revision was achieved in both cases. All flaps survived. Bone components achieved union in all cases at an average period of 4.8 months (ranging from 3 to 6 months). Based on Kapandji opposition score, the mean thumb opposition score was 6. The mean sensation of flap was 7.5 mm (ranging from 6 to 11 mm). No further flap revision or defatting procedures were required in all cases. Cosmetically acceptable results were achieved for all patients. Findings proved that thinned chimeric RCA perforator flap is a beneficial microsurgical alternative for reconstructing complex bone and soft tissue defects in thumb.

Reverse Dorsoradial Flaps for Thumb Coverage Show Increased Sensory Recovery with Smaller Flap Sizes.

Reverse homodigital dorsoradial (RHD) flap has been developed to repair soft-tissue defects of the thumb. However, few articles have reported this flap with long-term follow-up. This retrospective study was designed to evaluate the RHD flap and investigate factors affecting sensory recovery. From February 2010 to February 2011, 19 patients were treated consecutively with RHD flap without neurorrhaphy. At final follow-up, flap sensibility was assessed by Semmes-Weinstein (SW) monofilament, moving two-point discrimination (M-2PD), and static two-point discrimination (S-2PD) tests. Patient satisfaction, active range-of-motion of the joints, patient complications, and cold intolerance severity score questionnaire were sequentially evaluated. The patients were divided into two groups based on the S-2PD results and another two groups based on flap size. The mean SW monofilament sensitivity and M-2PD and S-2PD scores on the flap were 4.01 g and 9.26 mm, and 10.63 mm, respectively. Highly positive correlations existed between the flap size and the M-2PD and S-2PD scores. Moreover, in the respective groups based on S-2PD scores and flap size, no statistical difference was found among age, sex, and follow-up time, but the flap size and S-2PD scores were statistically different. RHD flap without neurorrhaphy is a recommendable technique for relatively small-sized thumb-defect reconstruction, which can achieve a satisfactory sensory recovery.

Bilaterally innervated dorsal digital flap for sensory reconstruction of digits

BackgroundProviding sensory coverage in digits continues to be a challenging problem. This study reports the sensory reconstruction of digits with bilaterally innervated dorsal digital flaps and compares the results between dual- and single-innervated flaps. MethodsOver 7 years, a retrospective study was conducted with 73 patients who had soft-tissue defect of the digit treated with the bilaterally innervated dorsal digital flap. There were 73 soft-tissue defects in 73 digits. The size of the defects ranged from 1.8 to 2.7cm in length (mean, 2.2cm) and from 1.6 to 2.2cm in width (mean, 1.9cm). The bilateral dorsal branches of the digital nerves were attached with the flap for the sensory reconstruction of digits. Reconstructive techniques included the cross-finger flap in 35 cases, the dorsal digital island flap in 24 cases, and the dorsal digital free flap in 14 cases. To objectively evaluate the efficacy of the bilaterally innervated flaps, we selected a comparison group that included 42 patients treated with the single-innervated flap. ResultsA significant difference was found between the dual- and single-innervated flaps in two-point discrimination, pain, Tinel's sign, and patient satisfaction results. By comparison, the dual-innervated flap presented better discriminatory sensation on the flap, lower incidence of pain and Tinel's sign, and a larger degree of satisfaction than the single-innervated flap. Of the dual-innervated flap group, the mean joint motion of the donor finger was similar to that of the opposite side. ConclusionsThe bilaterally innervated dorsal digital flap is a reliable alternative for the sensory reconstruction of digits. Performing double neurorrhaphies can improve flap sensation and reduce digital neuroma incidence when reconstructing a soft-tissue defect associated with both transected digital nerves.

Sensory Recovery with Innervated and Noninnervated Flaps after Total Lower Lip Reconstruction: A Comparative Study

This study compares sensory recovery after total lower lip reconstruction in a wide variety of flaps including bilateral depressor anguli oris flap, submental island flap, bilateral fan flaps, radial forearm flap, and pectoralis major myocutaneous flaps in a large number of patients. Spontaneous return of flap sensation was documented by clinical testing in the majority (3%) of patients who underwent total lower lip reconstruction. Sensory recovery occurred more often in patients with fasciocutaneous free flaps than in those with musculocutaneous flaps. Flap sensation to touch, two-point discrimination, and temperature perception was correlated with age, smoking, and radiation treated patients. We conclude that reasonable sensory recovery may be expected in noninnervated flaps, provided that the major regional sensorial nerve has not been sacrificed, and also provided that the patients age is relatively young and that enough surface contact area of the recipient bed is present without marked scarring. This trial was regestered with Chinese Clinical Trial Registry (Chi CTR) with ChiCTR-ONC-13003656.

Restoration of Thumb Sensibility with Innervated Reverse Homodigital Dorsoradial Flap

This study investigates the use of homodigital reverse dorsoradial flap with neurorrhaphy for thumb soft tissue defect. From 1996 to 2010, the homodigital dorsoradial flap was performed on seven adult patients and one 3-year-old boy. The flaps ranged from 1.2 to approximately 3.0 cm × 2.0 to approximately 4.2 cm in size. In six of the eight patients, the dorsal collateral branch of the radial nerve supplying the flap was also included in the pedicle and coapted to the proper digital nerves of the thumb. At final follow-ups, flap sensation, thumb motion, and donor-site morbidity were assessed. All flaps survived completely. At final follow-up of 8.5 months (range, 3 to 14 months), all patients except the 3-year-old child (who could not express clearly) reported satisfactory sensory recovery, with the static two-point discrimination ranging between 6 and 12 mm (mean, 9.4 mm). Range of motion of the metacarpophalangeal and interphalangeal joints of the thumbs was also preserved with minimal donor-site morbidity in all cases. Innervated reverse homodigital dorsoradial flap serves as a reliable and sensate flap for extensive thumb soft tissue reconstruction.

Distally Based Dorsal Digital Fasciocutaneous Flap for the Repair of Digital Terminal Amputation Defects

The preferred plastic surgery regimen for distal digital segment wounds remains unknown, although multiple options are available for the repair. The purpose of this investigation is to study its anatomic rationale and clinical outcomes, in addition to the role of dorsal digital veins in digital reconstruction. Patients (n = 765) suffering from digital terminal segment traumatic wounds (823 digits) were identified and reviewed in a retrospective manner. The wounds were repaired using distally based dorsal digital fasciocutaneous flaps with venoneuroadipofascial pedicles. Skin flaps survived in 818 digits (99.4%), whereas 5 flaps (0.6%) became partially necrotic. Postoperative follow-up data were available from 521 patients involving 559 digits, for an average duration of 10 months (range, 4-36 months). The wider pedicled fascial flap (1.0-1.5 cm) was significantly associated with a decreased occurrence of blebs, whereas the first few patients with pedicled fascial flaps 0.5 to 1.0 cm wide exhibited more frequent occurrence of blebs and flap contractures. The flaps retracted in size within the first 2 to 3 months at the rate of 10% compared with the intraoperative outlined size. The skin flaps became mildly pigmented within the first postoperative month, and at 6 months the flaps turned brighter in color, almost approximating the color of the normal digits. At 12 months, both the texture and appearance of the flaps were acceptable. The donor sites healed without any scar contracture. The digital terminals appeared grossly normal with acceptable digital function. Without any neural reconstruction, skin flap sensation was rated as S2 to S3+, whereas with neural reconstruction the 2-point discrimination sensitivity measured 4 to 9 mm. The use of a distally based dorsal digital fasciocutaneous flap with venoneuroadipofascial pedicle was a simple, safe, and less invasive regimen for repairing digital terminal segment wounds.

Functional and sensitive outcomes after tongue reconstruction: About a series of 30 patients

Few studies reported both functional and sensitive long-term evaluations after tongue reconstruction. The aim of this study was to assess functional outcomes and sensitive recovery after tongue reconstruction with fasciocutaneous free flap (FCFF) or musculocutaneous pedicled flap (MCPF) without nerve anastomosis. We enrolled 30 patients having no recurrence from a consecutive series of 79 tongue reconstructions as part of a cancer treatment. All patients were submitted to functional and sensitive tests. The functional study included intelligibility, tongue motility, food, and swallowing scores. Flap sensibility was evaluated too. Male-to-female sex ratio was 6.5 with a mean age of 52 years old. The lesions were mainly advanced (T3-T4 73%). Mobile tongue and base of tongue resection was carried out in 43% of cases, and resection was limited to the oral tongue for 53%. Twenty-one FCFF and nine MCPF were performed. The mean follow-up was 2 years and 11 months. Swallowing (slightly impaired 63%), food (normal 40%), and intelligibility (excellent 77%) assessments were satisfactory. Spontaneous sensory recovery was regularly observed (mean response 62%). The two groups FCFF and MCPF were similar regarding population and tumors characteristics. Functional results were higher in case of FCFF (food score p=0.05; intelligibility p=0.04). No difference was observed on sensitive recovery. This study emphasizes good functional results either for swallowing or intelligibility, with higher scores for the FCFF, strengthening the opinion that FCFF is the best choice for tongue reconstruction whenever possible.