Article
Innervated Reverse Digital Artery Island Flap through Bilateral Neurorrhaphy Using Direct Small Branches of the Proper Digital Nerve
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Authors
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Yo Han Lee
- Seoul National University College of Medicine, Seoul, South Korea
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Young Ho Lee
- Seoul National University College of Medicine, Seoul, South Korea
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Jihyeung Kim
- Seoul National University College of Medicine, Seoul, South Korea
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Yeun Soo Kim
- Seoul National University College of Medicine, Seoul, South Korea
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Che Ho Lee
- Seoul National University College of Medicine, Seoul, South Korea
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Young Ju Chae
- Seoul National University College of Medicine, Seoul, South Korea
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Qingyuan Li
- Seoul National University College of Medicine, Seoul, South Korea
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Goo Hyun Baek
- Seoul National University College of Medicine, Seoul, South Korea
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: The reverse digital artery flap uses the radial or ulnar surface of the proximal phalanx of the involved digit and has been applied to sensate flaps using the superficial sensory nerve branch and the dorsal branch of the proper digital nerve. As these nerve branches innervate the dorsal surface of the finger, however, hypesthesia of the dorsal side of the middle phalanx is inevitable.
In the present study, we successfully used the innervated reverse digital artery island flap through bilateral neurorrhaphy by using the direct small branches of the proper digital nerve. In a previous cadaveric study, the anatomical constancy of the direct small branches of the proper digital nerve was verified, and these branches have been used in the innervated lateral middle phalangeal finger flap.
Methods: Thirty fingers of 25 patients who had the innervated reverse digital artery flap using direct small branches of the proper digital nerve were included in this study. The minimum follow-up duration was 24 months, and the average defect size was 2.8 cm2.
First, the proper digital nerve and its direct small branches were dissected and preserved. Two or three branches that projected toward the donor flap were cut at the branching points from the proper digital nerve, preserving the proper digital nerve and dorsal branch of the nerve. The flap was then elevated and placed on top of the injured finger. Bilateral neurorrhaphy was performed, under a microscope using 10-0 nylon microsutures, between one or two direct small branches and the ulnar digital nerve stump, and between the branches and the radial digital nerve stump.
Results and Conclusions: In all cases, the pulp defects were successfully reconstructed with this flap. The average size of the donor flap was 3.9 cm2. At 6 months after surgery, the average static two-point discrimination value was 5.9 mm, the average moving two-point discrimination value was 5.0 mm, and the average Semmes-Weinstein monofilament score was 3.79. At 1 year postoperatively, the average Cold Intolerance Severity Score was 20. The percentage total active motion was measured at 99 percent 2 years after surgery.
Because this flap does not sacrifice the proper digital nerve or dorsal branch of the nerve, the sensibility of the dorsal aspect of the proximal and middle phalanx can be preserved. This flap is cosmetically excellent, as it uses a donor flap similar to the injured fingertip and the donor scar can be hidden by adjacent fingers.
