Sensory reconstruction of a finger pulp defect using a dorsal homodigital island flap.

Background: This article reports sensory reconstruction of a finger pulp defect using a dorsal homodigital island flap including double dorsal branches of the proper digital nerves.

Methods: From February of 2008 to December of 2009, the dorsal homodigital island flap was used in 15 fingers in 15 patients. The average patient age was 32 years. The injured digits included six index, six long, and three ring fingers. The mean size of the finger pulp defects was 2.4 × 2.0 cm, the mean flap size was 2.5 × 2.1 cm, and the mean pedicle length was 1.2 cm. Neurorrhaphy was performed between the dorsal branches of the proper digital nerves and the proper digital nerves at the recipient site. Flap sensation was assessed using static two-point discrimination and Semmes-Weinstein monofilament testing. For comparison, 28 patients treated using a cross-finger flap including a single nerve branch from February of 2005 to October of 2007 were included.

Results: In the study group, all flaps survived completely. At a mean follow-up of 19 months, the mean static two-point discrimination and Semmes-Weinstein monofilament scores on the pulp were 5.8 mm and 3.94, respectively. In the comparison group, the scores were 8.4 mm and 4.11, respectively. There was a significant difference between the two groups in static two-point discrimination and no significant difference in Semmes-Weinstein monofilament scores.

Conclusions: The dorsal homodigital island flap is an alternative for finger pulp reconstruction. The authors suggest performing double neurorrhaphies to improve flap sensation.

Clinical Question/level Of Evidence: Therapeutic, III.