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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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Reconstruction of multiple adjacent large finger pulps with the modified sensate free proximal ulnar artery perforator flap

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  • presenting/speaker Jiadong Pan - Ningbo 6th Hospital, Ningbo, China
  • Xin Wang - Ningbo 6th Hospital, Ningbo, China

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. DocIFSSH19-637

doi: 10.3205/19ifssh0455, urn:nbn:de:0183-19ifssh04558

Published: February 6, 2020

© 2020 Pan 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: To study the clinical effect of the reconstruction of multiple adjacent large finger pulps with the modified sensate free proximal ulnar artery perforator flap (PUAP).

Methods: From February 2013 to May 2016, 29 fingers in 13 patients with adjacent large finger pulp defects crossing the DIP joint were reconstructed by the modified senate free PUAP. In order to reconstruct the sensation of two pulps in each patient (26 pulps), both of the proximal and distal ends of the cutaneous nerve in PUAP were dissected and anastomosed. There were 8 fingers in 4 patients with the index and middle finger pulp defects, 12 fingers in 6 patients with the middle and ring finger defects, and 9 fingers in 3 patients with the index, middle and ring finger defects. The flap size was from 5 cm × 3.5 cm to 7.5 cm× 4 cm, and the perforator artery was anastomosed with the digital artery in 7 cases and with the joint branch of digital artery in 6 cases. The artificial syndactyly of two or three digits were divided in 7 and 12 weeks accordingly after the flap transfer.

Results and Conclusions: 12 flaps survived uneventfully except the venous congestion was found in one flap which was salvaged successfully by acupuncture bleeding. Also, no congestion or ischemia occurred right after releasing the artificial syndactyly. The time of follow up was from 11 - 32 months with the average of 18 months after the last surgery. The static two point discrimination of the two groups was (7.08 ± 1.14)mm and (8.23±2.12)mm, in which the pulp sensation was reconstructed respectively by the anastomosis between the digital nerve and the proximal or distal end of the cutaneous nerve in PUAP. These 26 sensate pulp flaps were also assessed by the Semmes - Weinstein monofilament test with the result of diminished light touch in 18 pulps and diminished protective touch in 8 pulps. The total active motion in all 29 fingers was (249±5.8) °. No patients but 2 suffered slight cold intolerance in the 2 insensate pulps.

Conclusion: The modified sensate free proximal ulnar artery perforator flap is a practical alternative for the reconstruction of multiple large adjacent pulps with satisfactory functional and aesthetic outcomes. Through anastomosing the proximal and distal end of the cutaneous nerve through PUAP with the unilateral digital nerve of two adjacent fingers, reliable sensation of the both pulps could be reconstructed.