gms | German Medical Science

Objectives/Interrogation: Usage of homodigital neurovascular direct flow flaps (NVDFF) in reconstruction of distal phalangeal amputations lead to minimal donor site morbidity with high rates of patients' satisfaction. We aimed to assess the results of these flaps with an emphasis on their objective sensorial status in comparison with contralateral healthy fingers.

Methods: Study was done in patients who were operated for an unrepairable distal phalangeal amputation between January 2016 and July 2018. Eleven patients (2 women, 9 men) with completed assessments were included. Mean age of patients at the time of operation was 32 (3-62) years. There were 3 index, 2 middle, 4 ring and 2 small injured fingers. Eight of amputations were distal to the level of DIP joint while 3 were disarticulations through DIP. Nail matrix had been lost totally in 5 patients while the other 6 have still partial or total matrixes. All of the patients, except 3-year-old child, were operated under local anaesthesia. In all of them a triangular shaped volar neurovascular island flap was dissected. In two of them a skin grafting of donor site was required. Assessment of study parameters was done at a mean time of 13 (2-33) months postoperatively.

Results and Conclusions: There was no flap necrosis in any of the patients. Ten patients rated their sensorial status as good and 1 as moderate. Seven patients rated their flap softness as good and 4 as moderate. Ten of them had no cold intolerance while one stated intolerance in some degrees. Five patients rated their overall satisfaction as very good, 4 as good and 2 as moderate. There was no flexion contracture in PIP joints while there were 2 in DIP. There were nail deformities in 2 patients.

Static two point discrimination test (2PDT) showed a significant difference (p=0,049) between the pulps of operated fingers (mean=4,45 mm, SD=1,57) and healthy contralateral hand fingers (mean=3,27, SD=1,00). Semmes Weinstein monofilament test (SWMT) showed no significant difference (p=0,157) between the pulps of operated fingers (mean=2,73, SD=0,65) and healthy contralateral hand fingers (mean=2,36, SD=0,50).

Subjective results of NVDFF's remain in an overall range of good, although joint contracture, cold intolerance and nail deformity remain as probable postoperative problems. Subjective results are also supported by objective assessments in this small study group. As a more reliable objective test than 2PDT, SWMFT showed that there is no difference between operated and non-operated contralateral fingers.