Repair of Soft Tissue Defect of the Finger Using the Heterodigital Neurocutaneous Island Flap

Not Applicable

Completed

Conditions: Sensory Reconstruction of the Volar Aspect of the Finger
The Heterodigital Neurocutaneous Island Flap

Brief Summary: The dorsum of the finger is a reliable flap donor site in reconstructive hand surgery because of its similar quality to the original. The dorsal digital island flap can be used for repairing the defect of adjacent finger, but the limited length of the pedicle precludes its use for a more distal defect. The heterodigital neurocutaneous island flap of the dorsal branch of the digital nerve can be used as an alternative to resolve this problem.

Detailed Description: At final follow-up, we measured the sensibility of the flaps using the Semmes-Weinstein monofilament test and the static 2-point discrimination test. The test points were at the center of the radial or ulnar portion of the pulp. The donor site, i.e. radial- or ulnar-dorsal aspect of the middle phalanx of the donor digit, was also evaluated. Each area was tested 3 times with a Discriminator (Ali Med, Dedham, MA). We stopped at 4mm as a limit of 2PD and considered this normal.

Recruitment & Eligibility

Inclusion Criteria

the soft tissue defects involving the middle phalanx, the proximal interphalangeal joint, or both;
a defect greater than or equal to 2 cm in length;
a patient between 15 and 60 years of age.

Exclusion Criteria

concomitant injuries to the dorsal skin of the middle phalanx of adjacent finger that precluded its use as donor site;
injuries to the course of donor nerve branch;
a defect less than 1.5 cm in length;
a fingertip or pulp defect;
a soft tissue defect of the thumb.

Arm && Interventions

Group	Intervention	Description
Surgical flap	the neurocutaneous island flap	The neurocutaneous island flap is based on the dorsal branch of the digital nerve

Primary Outcome Measures

Name	Time	Method
Discriminatory Sensation of the Flap	18 months to 24 months	Discriminatory sensation of the flap is evaluated with the Static 2-point Discrimination Test. The test determines the minimal distance at which a subject can sense the presence of two needles. The modified American Society for Surgery of the Hand guidelines were used to stratify Discriminator measurements (excellent \<6 mm; good 6-10 mm; fair 11-15 mm; poor \>15 mm. The test point is at the center of the flap. Each area was tested 3 times with a Discriminator (Ali Med, Dedham, MA). Two out of 3 correct answers were considered proof of perception before proceeding to another lower value. We stop at 4mm as a limit of 2PD and considered this normal. These assessments take place at a single time point at the final follow-up.

Secondary Outcome Measures

Name	Time	Method
Cold Intolerance	18 months to 24 months	We access the cold intolerance of the injured and donor fingers using the self-administered Cold Intolerance Severity Score questionnaire10 that is rated into mild, moderate, severe, and extreme (0-25, 26-50, 51-75 and 76-100).