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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Advancement of Homodigital Neurovascular Island Flaps

Meeting Abstract

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  • presenting/speaker Jin Xi Lim - National University Health System, Singapore, Singapore
  • Alphonsus Khin Sze Chong - National University Health System, Singapore, Singapore
  • Sandeep Sebastin - National University Health System, Singapore, Singapore

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1808

doi: 10.3205/19ifssh0452, urn:nbn:de:0183-19ifssh04521

Published: February 6, 2020

© 2020 Lim et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Homodigital neurovascular island (NVI) flaps are used for reconstruction of pulp defects. Previous articles have reported up to 22mm of flap advancement, although it is not clear from these studies, how flap advancement was measured and if flexion of the digits were required and to what extent. In our practice, we have not been able to achieve this degree of advancement. The aim of this study is to determine the maximal advancement of a homodigital neurovascular island flap. We hypothesize that extent of flap advancement correlates to the extent of dissection and the length of digit.

Methods: 27 cadaveric digits were dissected. The distance from the fingertip to the flexion creases for the distal interphalangeal joint (DIPJ), proximal interphalangeal joint (PIPJ) and palmodigital crease (PDC) for the fingers and interphalangeal joint (IPJ) and PDC for the thumb were marked and measured. A 1x1cm flap was designed on the radial and ulnar aspect of the pulp and sequentially elevated till the proximal interphalangeal joint crease, PDC, and bifurcation of the common digital artery. The ulnar digital artery of the index, middle and ring finger were then sacrificed and the flap dissected till the superficial palmar arch. The advancement of the flap at each dissection point was recorded.

Results and Conclusions: Average advancement following dissection till the PIPJ crease, the palmo-digital crease, following division of adjacent digital artery and till the superficial arch were 8mm (SD 2.5), 12mm (SD 3.6), 16mm (SD 2.8) and 19mm (SD 4.6) respectively. When dissection was done till the palmodigital crease, it was found that advancement was 20% of the digit length. We found that the Homodigital NVI flap could be advanced for a maximum of 19mm when dissection was carried out till the superficial arch with the digit fully extended. In addition, the degree of advancement can be predicted based on the length of the finger and is approximately 20% of finger length. We suggest that in future studies of flap advancement, authors should specify the method of measurement and quantify, if any, the degree of flexion of the PIP joint and MPJ. This will allow us to have a more accurate indication of flap advancement.